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Alpha752
10-22-2004, 12:28
Today in medic class I got into a little debate with another student on a senerio, and wanted other opinions.

The situation goes like this. Call for a GSW, found pt sitting on floor, leaning against wall, head down not responsive. GSW was to left temple. The debate comes in here. He wanted to leave the guy against the wall while doing a rapid trauma assessment. The guy was agional so that means trying to jaw thrust and BVM him while hes sitting against the wall. I wanted to c spine, assess ABCs, find agional breathing and lay him down to ventilate, then go on to rapid trauma. My buddy says he didnt want to move him untill he has had a chance to check him out. I just can see trying to jaw thrust and BVM someone sitting against the wall. Our instructor said both were right, just a diffrent approach.

Opinions from seasoned providers? Keep in mind we are still kinda by the book, learing street methods, but focusing on registry style care.

Thanks,
Russ

glockster96
10-22-2004, 13:16
Basically, do whatever you need to do to secure the ABCs and transport quickly. If it was me, I would have probably taken your approach: Secured c-spine, moved him down to a board if readily available, ABCs, transport, IVs, further assesment and other care enroute.

Steamboat Bill
10-22-2004, 13:21
Move him off the wall and onto his back. I've made this exact scene once and several very similar -- we have always placed them supine.

bubbagump
10-22-2004, 13:26
Originally posted by Alpha752
Today in medic class I got into a little debate with another student on a senerio, and wanted other opinions.

<snip>


I've been in this situation.

Here is what we did, dude lived.

1-secure c-spine
2-intubate, ventilate
3-NS via large bore x2
4-transport via air

have fun.

clubsoda22
10-22-2004, 15:40
Originally posted by glockster96
Basically, do whatever you need to do to secure the ABCs and transport quickly. If it was me, I would have probably taken your approach: Secured c-spine, moved him down to a board if readily available, ABCs, transport, IVs, further assesment and other care enroute.

I agree with glockster. opening his airway and using a bvm while he's seated sounds like a PITA (though i worked with a medic who tubed an entrapped vehicle occupant hanging upsidedown through the sunroof)C-spine, right to the board, ABC's. Trauma assessment you can do enroute. I know some guys who are campers and will spend a lot of time on scene assessing. On a non-critical, i will do this too, but on a critical i want to be rolling asap.

groverglock
10-22-2004, 15:40
ABC s

No obvious signs of death.

Continue treatment according to local protocol.

Air way ET tube or CombiTube, BVM, IV to push meds and fluids

fyrmedic
10-22-2004, 16:42
I always hated scenario training, with the rescue dummy sitting there and you walk into the room and the instrctor says here is the scene...It is hard to play make believe, but that is life I guess. Hopefully when you get out of school you get an experienced partner and in the field each scene is different. As a medic you learn that what was the right answer one time may not be the right answer another time. Clinical decision making is what sets the paramedic part from the EMT (whichever letters added to the end). So yes you may be rightand you partner may be right. I can't say,I didn't see the condition of the dummy.

twinfin
10-22-2004, 22:40
The beauty and simplicity of the ABC approach to assessment and treatment is that it really lines up the priorities. If the pt has agonal respirations with a gunshot would to the head then Airway must come first. If there is no airway and breathing, then nothing else you do matters. This pt obviously has compromised head position and agonal breathing so you must address that immediately before moving on.

I would like to suggest that you would be quite correct in moving the pt to the ground supine, and use your BVM with oral airway, cervical stabilization and ventilate the pt. I assume he has a pulse but you wouldn't check that before addressing the airway. Now you can move on in your assessment. The pt will likely get intubated soon but don't underestimate the benefit of good, patent basic life support level airway skills.

Alpha752
10-22-2004, 23:22
Thanks all. I think my partner was thinking a little more book style then I was. I have seen trauma calls and he hasnt, mabye that makes a diffrence. From my clinical trauma experience, I know that rapid trauma is just that RAPID. ABCs, and make sure nothing is going to kill them before you get them into the squad and go. You can play around in the truck. He was being a bit more cautious because we didnt know what was on the pt's back or anything. My mindset is in that situaiton, breathing comes first, forget everything else.

Anyway, thanks a lot. Im sure ill have a lot of these type of questions as I progress through the program, I appreciate the quick and informative responces. If anyone has an opinion to add, I would be happy to hear it.

Thanks again,
Russ

TerraMedicX
10-24-2004, 14:50
I'd say absolutely move him supine! Yes, I can intubate a seated patient in a crushed car (and have), but if you believe all that research coming out of CA then we already have a hard enough time getting our tubes in the right place, and I KNOW how much of a pain in th ***** trying to bag a seated pt is. So yes, put him in the position that is easiest to treat ABCs in that doesn't compromise C-spine stabiliztion. Then you have more room/flexability to control the airway.

My only other comment is that I'm a little concerned if you're in a paramedic program with someone who's never had trauma experience. Being a good paramedic is hard enough for those with experience!! Just the way I feel about it!

Nate.

glockster96
10-24-2004, 23:15
Originally posted by twinfin
The beauty and simplicity of the ABC approach to assessment and treatment is that it really lines up the priorities. ...

I couldn't agree more. In fact, I changed my signature for the first time in months to reflect it. :)

Slinger646
10-25-2004, 00:56
Originally posted by glockster96
Basically, do whatever you need to do to secure the ABCs and transport quickly. If it was me, I would have probably taken your approach: Secured c-spine, moved him down to a board if readily available, ABCs, transport, IVs, further assesment and other care enroute. ;Y ^6 ;Y

bubbagump
10-25-2004, 11:33
Originally posted by glockster96
I couldn't agree more. In fact, I changed my signature for the first time in months to reflect it. :)

Remember,

1) all patients eventually die.
2) all bleeding eventually stops.
3) if you drop the baby, pick it up.

Best,
X-medic

TerraMedicX
10-25-2004, 17:33
Originally posted by bubbagump
Remember,

1) all patients eventually die.
2) all bleeding eventually stops.
3) if you drop the baby, pick it up.

Best,
X-medic

;f

Don't forget: "Asystole is the ultimate in stable rhythms!"

Nate.

glockster96
10-25-2004, 20:49
Originally posted by TerraMedicX
;f

Don't forget: "Asystole is the ultimate in stable rhythms!"

Nate.

Hee hee hee.

"If you don't know what the rhythm is or how to treat it, wait a bit....it will turn into something you recognize." ;) ;a