dahlio Posted August 25, 2007 Share Posted August 25, 2007 You respond to an Motor Vehicle Accident involving 2 people. You are a BLS unit. The first woman is fine, and refuses medical attention. The other person, a male in his mid 50's, is walking around, confused. You ask him to come with you in to the ambulance, and he's not really following directions. You finally get him in to the ambulance and he sits down. What else do you want to know? Link to comment Share on other sites More sharing options...
Eydawn Posted August 25, 2007 Share Posted August 25, 2007 Let's start with the basics. I want a rapid trauma full body exam, especially focusing on the head and neck. Do I see any evidence of head injury, either from vehicle condition (windshield star, restraint evidence) or the patient's physical exam? If so, I want C spine to become a priority soon... While I was looking for injuries, did I see any medical alert tags? Baseline vitals: respirations, pulse, BP, pupils, blood glucose, skin temp and condition. Let's assess his mental status and see what we can figure out. Now that we've got a basic game plan, can we have a description of the scene please? Was this a vehicle-vehicle incident? 2 people in the same car hitting a stationary object? What direction, what kind of impact, etc.? Wendy CO EMT-B Link to comment Share on other sites More sharing options...
dahlio Posted August 25, 2007 Author Share Posted August 25, 2007 This patient doesn't have a scratch on him. Nothing on the head (except hair of course). Neck looks fine. Everything else is fine. This was a two car crash, they didn't hit each other. One was going 50 on the highway, and swerved just a bit scraping the guard rail, no injuries, minor damage to that car. The other car was crossing the highway, and landed in the woods, which is the car or patient was driving. The damage to the car suggested that he was traveling at a low speed. No spider web in the windshield, only real damage was to the passenger side. No air bag deployment, patient was restrained. No evidence of head trauma, steering wheel column/console were all intact. Pupils were PEARL. No medical alert tags. Vitals, B/P 182/86, Pulse 100 and regular, Pupils as state were PEARL, Blood Glucose is an ALS skill in NJ, unfortunately, Skin Warm/Dry. Mental Status was AO x 1. He knew his name, birthdate, medications and phone numbers, had no idea where he was, what had happened, or who the president was. Only medication he was on was for high blood pressure, which he claimed he took that morning. What else? Do you request medics? Link to comment Share on other sites More sharing options...
Cookie Posted August 25, 2007 Share Posted August 25, 2007 First off I would not have walked him to ambulance. I would have started with him right there standing C Spine and standing take down to backboard, base line vitals, rapid assessment. oxygen and spo2. His LOC is in question, I would request ALS. In any case this is significant MOI. Also repeat questions as to name, meds, location and so forth to see if that has improved or decreased, repeat vitals. If you cannot tier or meet with an ALS unit, load and go. The other person, someone should do a quick assesment with the persons permission. Even if they say they are ok, sometimes they are not and they don't know it. If they still refuse treatment, then be sure to get them to sign refusal. Link to comment Share on other sites More sharing options...
Eydawn Posted August 25, 2007 Share Posted August 25, 2007 Well, I was hoping diabetic or traumatic head injury as a cause for the decreased LOC. Nevvamind on that one... high blood pressure meds? BP 182/86? That's a bit high. Any evidence of slurred speech or motor deficit? I would get the ALS medics on the way, since I can't figure out a simple cause for this and my new worry now is some sort of CVA. (stroke) Let's get a set of breath sounds on this guy. Can basics in NJ place 3 leads? If so, a simple EKG strip would be nice to see. Does he take any vitamins? How much blood pressure medication does he take, and does he remember how many he took this morning? Reassess vitals while you're waiting for ALS and heading to the rendezvous point... or just haul butt if they can't meet up with you in a justifiable amount of time. What kind of damage did the passenger side sustain? Did the car dive off any kind of hill and land with a nice jarring motion by any chance? So let me get this straight- the cars never impacted each other? Two ships passing in the night? So you have 2 scenes then. Just for clarification. Wendy CO EMT-B Link to comment Share on other sites More sharing options...
dahlio Posted August 25, 2007 Author Share Posted August 25, 2007 ALS is a quick 3 minutes away. NJ basics cant do much of anything. No simple 3 leads. Passenger side damage is significant on the side. Yes, you do have two separate scenes. No vitamins, at least what he says. He's still very confused. Repetat B/P 154/92, pulse is 86. Board and Collar is now on him. Other patient is being checked out with your partner, and still RMA's. (and signs). What do you want to know? Link to comment Share on other sites More sharing options...
Eydawn Posted August 25, 2007 Share Posted August 25, 2007 How far out are you from the nearest facility? What's ALS intercept time? Any change in significant findings? Wendy CO EMT-B Link to comment Share on other sites More sharing options...
medic001918 Posted August 25, 2007 Share Posted August 25, 2007 ALS is a quick 3 minutes away. Shane NREMT-P Link to comment Share on other sites More sharing options...
dahlio Posted August 25, 2007 Author Share Posted August 25, 2007 15 minutes to the trauma center. ALS is 3 min. away, the opposite direction. Stay and play? Patient is constantly asking you what's going on, probably once every minute or so. edit: Forgot to mention, it's pretty much 15 minutes to any hospital, not just the trauma center, but that's where i'd take him. Link to comment Share on other sites More sharing options...
HellsBells Posted August 26, 2007 Share Posted August 26, 2007 With the repeatitive questioning it sounds like he may have a concussion, but the differentials here could be CVA, TIA, Hypoglycemia, Drug OD. Link to comment Share on other sites More sharing options...
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