Was I wrong?

[ninjaemtff]

Back in August, my company was dispatched along with an ALS unit to a baseball field for a possible head injury. Arrived on scene to find a 13 y/o male who was hit in the head with a rock. I boarded and collared the pt after doing my physical assessment during which I was able to clear all body parts, except for a laceration on the head and a headpain. Pts responses to questions were slightly delayed and bystanders who knew pt stated that he was not acting right. I then placed pt on 6 lpm oxygen via nc. We loaded pt into the Amb. I took initial vss Bp:122/74 P:76 R:16. After a few minutes with the oxygen, pt began to answer questions quicker and was answering all questions correctly. Due to this I cancelled ALS. Transported BLS, continued to monitor pts vss, pt rated his pain at about a 3 on a scale from one to ten and stated it just felt like a headache. I found out later that they ended up flying the pt out of our local hospital to a trauma center for a fractured skull. Was I wrong in cancelling ALS?

[Medic26]

If you had arrived 5 minutes later and found an alert and oriented patient who acted fine, you would have done the same thing, right? This one could have easily been transported either way. ALS or BLS.

You can what if a call to death but given what you've stated here I wouldn't have monday morning quarterbacked your call.

[Dustdevil]

Was I wrong in cancelling ALS?

No, but the agency was wrong for dispatching BLS in the first place.

Possibly wrong for doing c-spine.

Possibly wrong for administering O[sub:27168ce9e3]2[/sub:27168ce9e3].

Unless ALS was uber close, probably not wrong for cancelling them. Now, if your c-spine and screwing around on the scene lasted longer than it would have taken ALS to get there, then yes, you were wrong. But otherwise, sounds good to me.

How the hell big was this rock, and how fast was it going? :shock:

[akflightmedic]

Since the others gave you good answers, there is no point in repeating it.

However, I would like to comment on two other things as a learning opportunity.

1. 6 lpm through a nasal cannula is a lot! Put it on yourself and test it out, then ask if that was necessary. If it was necessary, why not a NR?

2. The pain scale is 0-10, not 1-10. We are trying to get away from that and her eis why.

The goal of pain management is to be pain free, right? So a zero, or nothing is the ultimate goal. If you are only getting them down to a 1, have you suceeded?

I know it seems like silly semantics but it does make sense.

[irme]

Was there any indications of a skull # ??

There was MOI that is for sure but wat about symptoms of a basal # such as echymiosis or CSF or battle signs.. These are all very late signs anyway and are highly unlikely.. (this is persuming it was basal which again is unlikely)

I dont think you did anything wrong, and i dont know that an ALS crew would have had a lot more to offer.. Like has already been stated the O2 at 6L should be substituted for a NRB or at least a hudson..

Also what was your indication for c spine immobalization? I see it done often and the pt has absolutley no complaints of central neck or back pain..

[medic001918]

I dont think you did anything wrong, and i dont know that an ALS crew would have had a lot more to offer..

An ALS crew may not have been able to do any more for this patient, but in the presence of a head injury an ALS provider can manage potential side effects of a head injury. Significant head injuries can come with respiratory compromise and seizures to name two big issues. That being said, I don't know enough about this call to make a good decision as to if ALS would have been warranted for this call. It sounds like it could go either way.

I might have been inclined to work this patient up simply based on there being people there who know the patient and say that he's not acting right. That indicates a potential injury to me. Head injuries can go either way with signs and symptoms. Sometimes the signs and symptoms will progressively improve with time, and other times they become more pronounced. You don't know which way they will go without waiting.

As far as c-spine, we can't spinally exclude someone if they have altered mental status per our protocol. But the whole spinal immobilization issue is a whole other topic that's been discussed. EMS as a whole tends to do it poorly, and more often than is really needed.

Without knowing more about the call, where ALS was coming from and your proximity to a hospital it's difficult to say if you were right or wrong. The bottom line is that the patient was transported to a hospital and then transferred to an appropriate facility based on their findings.

Shane

NREMT-P

[BEorP]

2. The pain scale is 0-10, not 1-10. We are trying to get away from that and her eis why.

The goal of pain management is to be pain free, right? So a zero, or nothing is the ultimate goal. If you are only getting them down to a 1, have you suceeded?

I know it seems like silly semantics but it does make sense.

"How bad is your pain on a scale of 1 to 10, with 1 being no pain at all and 10 being the worst pain you've ever felt?" This is how I would ask it. It is clear that "1" is pain free and the goal so I don't see an issue with this. (If you do not give a guideline of what "1" and "10" are then I understand your point though.)

[Chief1C]

Not exactly Wong-Baker.. But it looks good to me.

[align=center:eb37344886][/align:eb37344886]

I'm a zero to ten person, myself. I say "What's your pain, 0 to 10, zero being no pain at all; ten being the worst pain you've ever felt. Be honest, not brave, if it hurts, tells us how much, where, what makes it worse and if anything helps relieve it (i.e. positioning)."

If the patient isn't grimacing, flailing, screaming or in shock and says it's a ten. Then they're either paralyzed, stoned, heavily sedated, addicted and seeking or milking it.

[paramedicmike]

As to the original post, it's all been said.

As to the pain question, the goal is to achieve "zero" pain. Not a little pain...but no pain. Zero pain can't be quantified as "one" as that indicates there the patient is not feeling no pain (or zero pain).

Zero is devoid of any value. You wouldn't say you ran one call when you really ran zero calls, would you? So why would one suggest that they have a pain level of "one" when they really have no pain at all?

It's not just semantics.

-be safe

[AnthonyM83]

I say: How would you rate the pain on a scale from 0-10, with 0 being no pain and 10 being the worst pain imaginable.

I say "worst pain imaginable" because different people have felt different pain levels in their lives. If the person said 10/10 because it's the worst they've felt, then pain worsens, it takes you off the scale requiring extra explanation. Unless they're in absolute agony or drama queens, they won't say 10/10.

THOUGH, I have seen some guys who don't show pain at all by getting lost in thought or disconnecting...when you ask them if it hurts, you can hear in their voice they're doing their best to stay tough...and their injury type supports their pain rating.