Trauma or not?

[EMS_Cadet]

Alright guys....

You are just getting ready to eat when you are dispatched to an MVC. ETA is about 6 minutes.

You mark enroute.

Enroute, the FD advises that you have one minor patient with a possible broken nose.

You arrive on scene. Scene is secure. No obvious hazards except some light traffic which is being handled by PD and FD. No gas leaking etc. You put on safety vests and take BSI precautions. You note one elderly patient sitting upright in his vehicle. There is extreme damage to the front end of the patient's truck. Bystanders estimate the patient was going approx. 50mph when the patient ran into a stopped car. (Go figure!)

You approach the vehicle. Upon further assessment, you have an elderly male patient. He is bleeding from his nose. You are unable to see the nose injury due to FD holding compression with gauze. You note some minor lacerations on his left and right elbow area. The patient is A/O x 3. He denies any LOC. He denies any head, neck or back pain. In fact, the patient is only experiencing pain in his nose. You take the gauze off the patient's nose and see a large laceration all the way up the bridge of the nose. The laceration is quite deep. No other obvious signs of trauma to the facial area except for the nose laceration. No respiratory distress. Patient does not want c-spine precautions taken. He states, "I'm fine. Just need some sutures on my nose." You ask the patient how fast he was going. "I was going about 30mph." After talking the patient into c-spine precautions, you board and collar the guy. You get in the back of the truck. You expose the body for a full trauma assessment. You can find no signs of trauma (except for the nose issue). You ask the patient if he has any medical problems. He denies, but does say, "I have a neck issue." Patient cannot explain any better then that. The patient does donate blood, but hasn't donated within the past 48 hours. Patient appears to be in no distress. Vitals are as follows: Pulse: 72. BP: 142/94. RR: 22 and non labored. o2 sats: 100% on RA. You establish an IV (18g.) with NS for KVO.

Here comes the question....Do you classify this as a trauma and run emergent to the ER?

[MedicRN]

I would call this a Level II trauma and transport accordingly (no RLS)

Well.... obviously, he hit something with his nose. Was he restrained? What is the damage to the interior of the vehicle? Steering wheel intact? Windshield intact?

I would most definitely do spinal immobilization. What meds does he take? Medic Alert tags? Any evidence of old surgical scars on chest or abdomen? Blood sugar level? What does the monitor show? Are there any motor/sensory deficits? Pupils?

A Level II trauma patient here gets a minimum high-flow O2, large bore IV X1 with LR at TKO, cardiac monitor and a trip to the local Trauma Center.

[chbare]

EMS_Cadet, I would call this a trauma. However, light, sirens, and driving like a speed demon could end with me smashing into a soccer mom/dad van full of kids. My ER director has done a good job of decreasing all of the "emergent" calls in my county, and I honestly feel that the patient, EMT's, and streets are safer for this.

MedicRN, excellent call on things to assess.

I hope this helps.

Take care,

chbare.

[Ridryder 911]

Yes & NO !!

Again, what reason would anyone have to "run" with patients ?... Did we miss something in Basic EMT classes on differential of someone being severely injured and not ?

Does this patient have or represent any airway, breathing or circulatory compromise?... any LOC change ..no ?.. Any gross hemorrhaging ?.. no.. no neuro deficits.. no other signs of major trauma or incidence of trauma ...

I also question the treatment .. why the I.V.? Are you going replace fluids?.. Was there enough blood loss to even be concern of this ?.. Are you going to give meds?.. Why are you establishing an IV ?.. again why do you need one ? Please, don't recite protocols.. have a valid rationale. This is an obvious simple trauma call.. if he is aware of why the incident occurred (no syncope, etc)

C'mon folks .. just because they were involved in trauma, does not mean they meet trauma criteria and definitely does not mean they need a level 1 trauma center.

Our trauma surgeon, just ripped a new one on a EMT because of GSW to extremity (single shot . through & through, good perfussion intactness) for bringing it in emergency and for not appropriately triaging it to a lesser level..Level II or even III. Over triaging places burdens on overtax T.C's and poorly represents EMS in a whole.

If you don't know your local standards and standard of care for any trauma ... better start reading & learning!

R/r 911

[chbare]

Ridryder 911, I agree. If you work in an area that has multiple hospitals, you need to know your protocols and be able to triage your patients appropriately. We only have one hospital in our county, so we get all the calls. We have had problems with ambulance crews that run every call emergent (lights, sirens, speeding like a maniac) regardless of the patients condition, and I feel safer now that people are starting to use common sense.

Take care,

chbare.

[MedicRN]

C'mon folks .. just because they were involved in trauma, does not mean they meet trauma criteria and definitely does not mean they need a level 1 trauma center.

Level I is all my little wide spot in the road has - two of them to be exact. We don't have the luxury of a Level II or III or even IV.

If you don't know your local standards and standard of care for any trauma ... better start reading & learning!

What I gave was LOCAL and STATE protocol. Gotta remember, my dear Rid, not every systems functions as Oklahoma does.

[EMS_Cadet]

I would call this a Level II trauma and transport accordingly (no RLS)

Well.... obviously, he hit something with his nose. Was he restrained? What is the damage to the interior of the vehicle? Steering wheel intact? Windshield intact?

I would most definitely do spinal immobilization. What meds does he take? Medic Alert tags? Any evidence of old surgical scars on chest or abdomen? Blood sugar level? What does the monitor show? Are there any motor/sensory deficits? Pupils?

A Level II trauma patient here gets a minimum high-flow O2, large bore IV X1 with LR at TKO, cardiac monitor and a trip to the local Trauma Center.

The patient was restrained. The damage to the interior of the vehicle was moderate. Steering wheel was intact. Windshield was not intact. The patient did not take any meds. No medic alert tags. No signs of past trauma/surgeries. Blood sugar is 142. NSR on the monitor. No neruo deficits. Pupils are equal and reactive.

[EMS_Cadet]

The patient starts asking if he can sit up. You ask the patient why, but you get no reasonable response. The patient keeps asking if he can sit up. You finally are able to "prop" the LSB up with some folded sheets and a pillow. The patient states, "That's better."

Wanna change/add anything based on that?

[AZCEP]

Facial injury that can drain into the oropharynx might be a good reason to use a KED.

Don't want this guy to drown in his own blood, now do we.

As long as he can maintain his own airway, even with a little help from our friend Yankauer, he can go somewhere besides a trauma center.

Any odors of adult beverages? Can he answer your questions appropriately? Does he remember the incident, and the events preceding it?

[EMS_Cadet]

Facial injury that can drain into the oropharynx might be a good reason to use a KED.

Don't want this guy to drown in his own blood, now do we.

As long as he can maintain his own airway, even with a little help from our friend Yankauer, he can go somewhere besides a trauma center.

Any odors of adult beverages? Can he answer your questions appropriately? Does he remember the incident, and the events preceding it?

He is maintaining his own airway fine. The blood is coming out into the gauze, not draining in his airway.

No odors of alcohol. He can answer our questions fine. He remembers the incident perfectly and the events preceding it.