20-Foot Fall

[Rezq304]

Dispatched to scene of a rural home....male pt fallen approximately 20 feet........on scene time 10-12. Closest facility 10. Closest trauma facility 45. GO.....

[Ridryder 911]

Let my Rookie run the call.... Hey, Senority does have its' place.... :wink:

R/r 911

[docspoon1666]

"C-med check the status of a chopper"

[Rezq304]

"C-med check the status of a chopper"

Chopper is confirmed unavailable as you check on scene.

[rat115]

You know that these are very different for those who are in the rural areas compared to those who work in major areas. Here's what we'd do here. (Rural) 8)

Have a bvm and o2, c-collar, and long board ready when we arrive on scene. Alert hospital that they need to have a trauma team and x-ray techs activiated. Call for a flight to be started en route to the airport and have a second crew head out to pick up the flight crew. Rapid trauma assessment while getting the pt c-collared and long boarded. Obtain vitals, load the pt and go. Start IV while en route and go back over the pt for anything that might have been missed. Call in a report to the hospital to give them an idea of what we found so that they are prepared.

Airway intact? Any life threats to be delt with as a priority? What was found during the trauma assessment? Family or others around to get medical history? (IE: Is the main concern only the fall or is there pertinant medical history that we need to be concerned about?) Pt on any meds espically any anticoagulants? Motory and sensor in the extremities?

[Rezq304]

Airway is clear. Pt is breathing 24 times per minute, good depth and volume. Skin is pink. During assessment, you note deformed R shoulder and pain on palpation in the upper two abdominal quadrants. Only medical hx is the pt had two spots of carcinoma removed over a decade ago. BP- 100/P P-96 O2 Sat- 95. Interrogation of the family reveals that the gentleman was painting the roof of his barn, when his harness rope snapped allowing him to fall approximately 10 feet onto an overhang on which he landed on R shoulder. He then rolled off of the overhang and landed on the grass 10 feet down on his R shoulder. Motor sensory is intact. Trachea mid-line. (-) JVD. Lungs clear and equal bilateral. (-) Sub Q Emphysema. (-) deformity to spinal column on palpation. Pt is c/o no other pain than the upper abdominal & R shoulder. Pt is AAOx3.

Ok, you have your IV, but where do you want to put it, what size, & how do you want it to run?

[chevy]

I'll take a stab (no pun!)

Due to -JVD, trachea midline, normal sensory rxn and lung sounds, rule out tension pneumothorax, cardiac tamponade. Hypotension, reduced sat and slightly tachy point to possible hemothorax or aortic tear with accompanying hemorrhagic shock.

IV - not sure (I'm a student, starting next month!), but I'm betting bigger is better here (18 -20) if pt. goes down hill due to shock or SAT's drop due to progression of hemo/rupture. Run IV at 250 ml but be prepared to increase flow to compensate for blood loss if vitals change. Transport top priority using whatever means available in your area and accounting for weather/closeness to trauma centre.

[Rezq304]

Chevy, you're right, the bigger the better in case you need to infuse blood products. I'm not sure what everyone elses protocols call for, but here where I'm at, the hospitals want nothing smaller than an 18-gauge used on a trauma pt.

[Ridryder 911]

As other noted of course spinal precautions, pay close attention to abdominal pain (LUQ), and as well not bolus him with to much fluid. Since this is really more of multiple fall and not a direct 20' fall, I would as well be monitoring a detail neuro assessment.

Transport destination. it all depends what is the closet rated and what services that hey can provide, Level II can perform about as much as Level I. Rendezvous with helo possibly if closest does not have surgical suite availability. Remember, not all trauma patients require a Level I...

R/r 911

[rat115]

Ditto what was said above. The IV needs to be in the left arm to prevent movement of the right since there is pain in the right shoulder. (I'd use an 18 gauge.) This also prevents problems in treating any shoulder injury once at the hospital. Watch the pt and repeat vitals every 5 minutes to make sure that the pt isn't going downhill due to something in the abdomin.

I would use the long board straps to help hold the right arm in place if the pt tolerates the arm close to the body. If not, place a pillow between his body and arm in a comfortable position and "strap" it in place with "ace" wraps wrapped around the pt and board.