chbare Posted October 7, 2009 Posted October 7, 2009 You are a member of a two person flight crew on an EC-145 configured for two patients and you have been called to the location of a one car rollover with ejection and two patients. Take it away. Take care, chbare.
FireMedic65 Posted October 7, 2009 Posted October 7, 2009 (edited) Day or night? Time of year. type of weather? Vehicle stabilized? Ground EMS on scene? If so, what do they say they have. Is there extrication needed? Patient conditions? Stable (probably not), any obvious injuries, has ground EMS (if they are there) done any treatment? Approximate patient weight? Distance from appropriate hospital? edit: Do I need my graphing calculator? Edited October 7, 2009 by FireMedic65
scubanurse Posted October 7, 2009 Posted October 7, 2009 the y=mx+b really threw me off! I had terrorizing flashbacks to geometry in 8th grade! Ditto to what Fire said... but also how far are the patients from the car... what local support do we have on ground... Are we sure it's only 2 patients and a third didn't get ejected further from the other 2? (I've had that happen with rollovers someone gets ejected on the first bounce and the car keeps going for another 50 feet...no bueno!)
CAPMEDIC-EMWFR Posted October 7, 2009 Posted October 7, 2009 My gut instict on this scenario (being that we aren't on scene yet) is that you are going to try to throw us for a loop on the whole scene safety bit. Other than that I really don't have much to add. Possibly consider sending for another air unit deponding upon local ground response - IE if ground is not on scene yet, why were we called first in? Other than that, not much else to add... And going off the scene safety topic, if ground is not on scene, do we have an appropriate (and secured) LZ?
chbare Posted October 7, 2009 Author Posted October 7, 2009 Early afternoon with good weather and visibility. Two patients that weigh about 60 kg a patient. Extrication of one patient in progress. Volly fire department on scene providing first responder care and extrication. You are 60 minutes by air to the trauma center and 10 minutes from a county hospital with minimal resources; however, they have a general/vascular surgeon on call. Scene and LZ is secured and you land without incident. Two patients: Patient Y: 19 year old female driver is trapped in the remains of the car. You not extensive damage to the car. The patient is unresponsive. Patient X: 19 year old female front passenger was ejected from the vehicle and landed about 20 feet from the car. Patient is unresponsive and it look like the first responders have placed an LMA and are bagging her rather aggressively. Non-patient M: 20 year old female who was a restrained back seat passenger is available to answer basic questions. Take care, chbare.
46Young Posted October 7, 2009 Posted October 7, 2009 the y=mx+b really threw me off! I had terrorizing flashbacks to geometry in 8th grade! Ditto to what Fire said... but also how far are the patients from the car... what local support do we have on ground... Are we sure it's only 2 patients and a third didn't get ejected further from the other 2? (I've had that happen with rollovers someone gets ejected on the first bounce and the car keeps going for another 50 feet...no bueno!) An engine company should be dispatched to all MVA's, as well as a heavy rescue for cut jobs. The engine can position to effectively block the scene, and pull a bumper line if needed. What many don't think about is using the thermal imaging camera to search for additional pts who may have been ejected out of sight. This is what my FRD advises us abour Air Medical Transport: The routine use of Air Medical Transport based SOLELY on mechanism of injury (MOI) should be discouraged. The decision to transport by air must take into account a number of factors. 1. Logistical factors - access and time/distance variables. -Proximity to the receiving facility -Traffic congestion -Topographical factors limiting patient access by ground or water transport units -Availability of and proximity to an acceptable landing zone 2. Patient factors Trauma - MOI significant enough to require transport to a trauma center plus one of the following anatomic/physiologic abnormalities - Compromised airway, cannot be maintained or managed -Respiratory distress/failure -Signs/symptoms of hypoperfusion/shock -GCS of 10 or less; GCS decreasing two points from 1st and 2nd assessment -Loss of consciousness more than five minutes -Neurological signs/symptoms suggestive of spinal cord injury -Two or more long bone fractures/deformities Medical/Surgical (suspicion of the following) -Acute ST elevation MI with S/Sx of shock or severe CHF -Ruptured AAA (abdominal pain/back pain and hypotension) -Aortic dissection -Acute ischemic CVA (stroke) less than 3 hours from symptom onset Contraindications to Air Medical Transport -Pt has no obtainable vital signs upon initial assessment and remains without vital signs during the course of the resuscitation effort -Pt is contaminated with a hazardous material -Patient's condition requires multiple caregivers and/or space to provide CPR -Pt size (consideration) -Patient's injuries (grossly angulated fractures)
Kiwiology Posted October 7, 2009 Posted October 7, 2009 I really would like an Advanced Paramedic, preferably one capable of RSI. Patient Y: Have my partner check on the her looking for obviously fatal injuries (brain matter, steering wheel through torso, transection etc) and whether or not she is breathing. If not breathing, manually open the airway and check again; if she is not breathing then given the probability for massive internal injuries and distance to a trauma centre I'd be happy to not continue on her. If she is breathing then drop an OPA, start on O2 at 8lpm NRB, C-collar and do as much of a primary survey as we can while getting her cut out. Patient X: - Primary survey; any obvious injuries? - Make sure the LMA is in place and working well; let the Firefighters carry on bagging her - Vitals: GCS/HR/BP/SPO2? - IV access and cardiac monitor - Once that's taken care of start a secondary survey Non-patient M: - How fast do you think you were going? - Do any of the patients have any medical history? - Does it hurt in your neck or back anywhere? - Did you get knocked out/do you remember everything?
Kiwiology Posted October 19, 2009 Posted October 19, 2009 ... did we ever get a resolution to this scenario?
chbare Posted October 19, 2009 Author Posted October 19, 2009 I really would like an Advanced Paramedic, preferably one capable of RSI. Patient Y: Have my partner check on the her looking for obviously fatal injuries (brain matter, steering wheel through torso, transection etc) and whether or not she is breathing. If not breathing, manually open the airway and check again; if she is not breathing then given the probability for massive internal injuries and distance to a trauma centre I'd be happy to not continue on her. If she is breathing then drop an OPA, start on O2 at 8lpm NRB, C-collar and do as much of a primary survey as we can while getting her cut out. Trismus noted, unable to place OPA, breathing about 8 times a minute. Patient X: - Primary survey; any obvious injuries? - Make sure the LMA is in place and working well; let the Firefighters carry on bagging her - Vitals: GCS/HR/BP/SPO2? - IV access and cardiac monitor - Once that's taken care of start a secondary survey LMA is in proper position and functioning well, GCS-3, Bruising under the eyes, behind the ears, and to the right zygoma, SPO2- 100%, IV access established and patient, waveform capnography initiated: plateau shaped waveform with an ETCO2 of 17. Non-patient M: - How fast do you think you were going? 60 km/hr - Do any of the patients have any medical history? Non Known - Does it hurt in your neck or back anywhere? Nope - Did you get knocked out/do you remember everything? Nope/Yes Take care, chbare.
Jwade Posted October 20, 2009 Posted October 20, 2009 (edited) Take care, chbare. CH, Great post, Just wondering about your algebraic straight line graphing equation? Simple Linear Regression The objective of simple linear regression is to determine the straight-line relationship between a dependent (y) variable and an independent (x) variable. This includes a single explanatory variable, or how much of the variability in the dependent variable (y) can be explained by the independent variable (x). When several explanatory variables exist, a multiple regression analysis is performed. For this paper, three simple linear regression analyses are performed. Linear relationship hypothesis are as follows: H0 p(rho)=zero HA p (rho) does not = zero The author will want to reject the null hypothesis and accept the alternative, or show that there is a linear relationship. Respectfully, JW Edited October 20, 2009 by Jwade
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