Guest Posted April 18, 2006 Posted April 18, 2006 Ok: Heres how it starts. You are Working as an EMT (I) your on your final field evaluation, on a Advaced Life Support truck, its AM shift Change and your lazy Paramedic is is drinking his first cup of Tims. You are working in a Urban Center with Transport times up to 50 minutes.You have checked out your truck, all is in order, all the toys you want, and in good working order. Kevkie is the Paramedic! :twisted: THE CALL: 911- urgent, 66 yr old Man fell off a Roof, Awake and Talking, a possible leg fracture.... informed by Dispatcher. Time out 09:12 hrs Response to scene 38 minutes.....way out in suburbs, new homes under construction and its Saterday?wtf? Scene Safety: construction materils, no electrical power concerns but there is frost on the ground, its slippery. 69 yld male, found on top of some debris. Awakeing and Talking, GCS 14 Lots of Pain! 9/10 Appears pale in color. Appears that he has 2 knees to left leg. Lets just say that spelling and terminology dont count. Some fore shadowing here, make sure the basic stuff is taken care of first but it may get complex really fast. OK 1 2 3 GO! this may be a fun one :twisted:
PRPGfirerescuetech Posted April 18, 2006 Posted April 18, 2006 Ok: Heres how it starts. You are Working as an EMT (I) your on your final field evaluation, on a Advaced Life Support truck, its AM shift Change and your lazy Paramedic is is drinking his first cup of Tims. You are working in a Urban Center with Transport times up to 50 minutes.You have checked out your truck, all is in order, all the toys you want, and in good working order. Kevkie is the Paramedic! :twisted: THE CALL: 911- urgent, 66 yr old Man fell off a Roof, Awake and Talking, a possible leg fracture.... informed by Dispatcher. Time out 09:12 hrs Response to scene 38 minutes.....way out in suburbs, new homes under construction and its Saterday?wtf? Scene Safety: construction materils, no electrical power concerns but there is frost on the ground, its slippery. 69 yld male, found on top of some debris. Awakeing and Talking, GCS 14 Lots of Pain! 9/10 Appears pale in color. Appears that he has 2 knees to left leg. Lets just say that spelling and terminology dont count. Some fore shadowing here, make sure the basic stuff is taken care of first but it may get complex really fast. OK 1 2 3 GO! this may be a fun one :twisted: Vitals? WTF is "tims"? Availability of flight services?
Eydawn Posted April 18, 2006 Posted April 18, 2006 Vitals. How far did he fall? I'm assuming C-spine is an issue- so grab the backboard and c-collar. Pertinent history of similar/other injury? Medical conditions? Why'd he fall? What hurts most now? Allergies? Meds? Last oral intake? Pupils? Any signs of head injury? Respiratory distress? That'll do for starters. Wendy NREMT-B
Guest Posted April 18, 2006 Posted April 18, 2006 Good start: Ok unless you are specific I will only give the basics! Im a tough SOB Tims is the best coffee in North America, Kevine likes his 2 sugars, 2 creams. V/S: Resps: 24 irregular pattern possibly due to pain? Pulse 64 regular, radials are weak. BP: 90/50
Guest Posted April 18, 2006 Posted April 18, 2006 "Eydawn"]Vitals. How far did he fall? I'm assuming C-spine is an issue- so grab the backboard and c-collar. Pertinent history of similar/other injury? Medical conditions? Why'd he fall? What hurts most now? Dont assume one damn thing here! A volunteer figher fighter sees the comotion from down the Street. Can I help? Damn right you say: Can you please hold C-spine Thank you very much Mr. Vollunteer do you work for free? :wink: You send that Lazy Paramedic to get the Board! But a Great question, are you asking me or the patient?????? Why did he fall? and yes he did approximatley 14 feet, good thing I'm not giving you metric EH! You also not skidmarks like dancing all over the frost covered roof, from the peak down. Allergies? Meds? NKA. Yea: some heart pills, a yellow one (small) and another one I dont know its at home. He says Can't You see my GD leg is busted? Are you NEW? Last oral intake? Breakfast, @ TIMS HORTONS......LMAO! 2 eggs toast, and bacon. Pupils? PERL Rapid reaponse to Direct and good Consentual response. Any signs of head injury? Are You asking for all Secondary P/E? not yet! twisted squint says. No loss of C, but C/O dizzyness. Broken glasses found 10 feet way. Respiratory distress? As before RR: 24 no obvious indrawing, no splinting of resps..... Have you asked for Chest sound, heres a free bee.....Good A/E bilaterally, no wheeze noted, some fine bibasalar creps/ fine crackles. That'll do for starters. Wendy NREMT-B
N.S. ACP Posted April 18, 2006 Posted April 18, 2006 pain - only in extremities or any where else...head,neck back? Lung sounds - ?, SOB? chest stable, any pain, symetrical rising, flail segments,etc Abd, - distension?, tender to touch, bowel sounds head to toe any other fractures noted on secondary and lac's or external bleeding? Reason he fell, did he trip, weakness, pass out, etc. This should keep ya going for a few mins Squint :pottytrain2:
RaceMedic Posted April 18, 2006 Posted April 18, 2006 What was he doing? Does he remember the event? What else did he hit besides the ground? any other painfully obvious injuries or bleeding? Any thing notable in the abdominal region? guarding, distention, heat, soft or firm, growing? i want two IV's for trauma? What the Past medical Hx?
Guest Posted April 18, 2006 Posted April 18, 2006 pain - only in extremities or any where else...head' date='neck back?[/quote'] Yea my damn leg....you new too? Done, review.....hey I type slow give an old guy a break! Ok seeing as u ask, yes stats the patient, I have trouble sometimes catching my breath when I walk 2 flights of stairs. :twisted: Lead me and It gets tougher! review, no flail, no pian on palp. Nope! Nope Nope. He He, yes, You ask cause yer really smart...... Hows your Vision?...answer.....every thing looks yellow.....(no not BLUEISH) Oh yea of the East Coast. :twisted:
rocket Posted April 18, 2006 Posted April 18, 2006 I concur with what the others have said so far and have this to add: O2 via NRB 15 L. "lying on top of debris" could mean a million little hidden things underneath him. Any obvious bleeds? Is the 2nd kneecap above of below the first one (in other words, is this a deformity in the femur area or tib/fib). Assuming 02 therapy started with no obvious bleeds I'm gonna let the Medic do the ALS thing (i.e., determine if pain mgmt meds are advisable with those vitals...esp BP, start the line(s), etc) and I will do the BLS thing. Let's get a good feel for the stability of the thorax and tenderness/rigidity of the abdomen. I'll report what I find to the medic and perform the intervetions I can given supplies and protocol for anything I find that is amiss. Let's cut and expose to see if anything else has holes in it/is pointed the wrong way/otherwise damaged etc. As mentioned above I want to get a look at the posterior sections in particular. Let's get a quick set of pulses and neuros on all 4 limbs. What do I find? What is the skin temp like from limb to limb, trunk to limbs, etc. I'll ask quickly why he is on heart meds. This may/may not help explain the lung sounds and/or why he fell. I'll also ask if he is a diabetic. Maybe a BGL check to explain why he fell/why he is "dizzy" right now. Let's grab some towels and build up the space under (and stabilize) that leg. If it's a femur injury then I might pull manual traction now and ask the medic to go get the traction splint. And while you are at the truck could you grab some cold packs, board splints, pillows and cravats? I dunno how we are going to stabilize this limb yet given the scenario but we do want to get moving quickly. I think we need to get him packaged and moving ASAP. That boils down to addressing the ABCs, stabilizing the limb and properly immobilizing the patient. He's already in it deep given the response time and if there is anything else amiss internally he will need to reach definitive care quickly. I'll give the area another quick once-over as I am picking up our toys...do I see anything telling in the accident scene or shall we learn the rest of the story in the truck? -Trevor
Guest Posted April 18, 2006 Posted April 18, 2006 What was he doing? Helping my son put a roof on? You think I was up there for fun? Does he remember the event? No Loss of C....yes got dizzy and slipped. What else did he hit besides the ground? A bunch of garbage...2x4s any other painfully obvious injuries or bleeding? Nope! Any thing notable in the abdominal region? guarding, distention, heat, soft or firm, growing? Nope! good questions! i want two IV's for trauma? Ok 2 lines.....How fast you going to run em? ps, little yellow pill hmmmmm. His Son states: got checked out for Chest Pain a year ago, but hes stuborn old man! What the Past medical Hx?
Recommended Posts