medical scenarios

What would you do?
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firefighter26
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Joined: Wed Dec 31, 1969 7:33 pm

Postby firefighter26 » Fri Sep 01, 2006 7:22 pm

NEW SCENARIO

---------------------------------

It's practice night and you've pulled the trucks out of the hall. You and a few guys are standing around chatting in front of the firehall when you hear the sound of a car's breaks locking up. Looking up, you see a mini-van skidding to a stop in the gravel, but not in enough time to avoid a child on a bike. The bike is clipped and the child is knocked off and to the ground, hard.

You and your guys instinctively run to the roadway. The child is laying on the ground, semi-prone, crying loudly, with numerous cuts on his arms and legs, including a deep cut, bleeding heavily, on his forehead.

EHS will be 10 minutes.

How will you bandage and package this PT prior to their arrival?

GO!
"No one ever called the fire department for doing something smart"
- Unknown

"If you don't like what you see, Why don't you fight it?
If you know there's something wrong, Why don't you right it?"
- Trooper

beetlebailey
Posts: 7
Joined: Wed Dec 31, 1969 7:33 pm

Scenario #1

Postby beetlebailey » Sun Sep 10, 2006 5:18 am

Once on scene, I would notifiy control that we have arrived on scene at 661 Becknall Avenue and do have visual contact of a male patient slumped over in a sitting postion at a picnic table and to stand by for updates. As I survey the scene from our unit, I do notice that a vehicle is irradically parked on this property, half on the drive and half on the lawn. I also take into account a large crowd is starting to gather, just as the man gets up and takes a few steps and passes out again face down on the lawn. At this time I ask control to dispatch police because I dont know how many people this patient has upset with his driving to where the vehicle is now. I tell the guys to grab the trauma bags and AED and my extra guy to grab a hally bar, just incase! As I get out, the woman who called 911 greets me and is talking AT me a mile a minute. I calm her down and start to ask questions before I allow my guys to approach. I ask, do you know this gentlemans name ?She says and that his name is Steve.I asked if she knew his age ,which she replied 47.Does he have any medical conditions you know of ? She answers "no". I ask if she knows if he is a drinker or if there is a chance he may have been drinking today? She thinks"maybe" because his girlfriend recently moved out. I asked" does he have any dogs or animals we need to worry about? She replies"no" and adds that he is the only one she has seen there for the last hour or so. At this time I thank her and ask her and everyone else to kindly step off the lawn and down to the curb.Just then a police unit shows up as we approach the patient calling out to him by his name "STEVE" I yelled, I'm with the fire dept. can you hear me ? No response, we kneeled right down to him with one of my guys at his head and myself and the third member of our team to Steve's left.(reason being I know we are going to have to roll this guy and the picnic table is to close on the other side ) I again called out to him "Steve". This time with a grunt for a response. I again introduced myself as the fire dept. and started to advise him as to what I was about to start doing, interms of feeling for a carotid pulse and getting close to rate his breathing. His pulse was 94, reg and full and his breathing was effortless at 16 resp. per min. At this time wemaintained a "C" hold and rolled him over onto his back. There was no signs of any blunt force trauma or bleeding or any reation of painfullness as I did a primary survey of him. We at this time for procautionary reasons applied a cervical collar and and put him on O2 via nrb at 15l/min and maintain a "C" hold. When I reassessed his breathing I was trying to detected an odour of alcohol, but I didn't want to put on the "blinders" and just assume this guy as being drunk! I was also trying to detected that sweet acutonig scent that diabetics get. So, I did blood sugar level readind rule out any type of diabetic emergency. His blood sugar level was fine and within a safe range. At this time, although I haven't determined what is wrong with this guy, I still haven't deemed him critical and called for ambulance back up as of yet. I reassessed his bp and there was no change and pulse seemed to be settling down to a normal range around 70. At this time Steve starts to become more coherent and is a little adjitated with the cervical collar. I advised him he was fine and that the collar was for procautionary measures and he seemed to become more at ease. As I started to ask him questions he addmitted he had been drinking all day and had recently begun taking anti-depressants,which must of had an effect with the amount of alcohol he had consumed through the day, so it was at this point I called for ambulance to transfer him for observatio, so we boarded him and prepped him ambulanec.
Last edited by beetlebailey on Sun Sep 10, 2006 5:31 am, edited 1 time in total.

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FireEMTGuy
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Postby FireEMTGuy » Fri May 25, 2007 3:37 am

Per above post: call EMS early, don't wait and try to make a diagnosis on your own.

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FLASHOVER05
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Postby FLASHOVER05 » Sat May 26, 2007 10:56 am

FireEMTGuy wrote: don't wait and try to make a diagnosis on your own.
Wait a minute... you'll have an angry Resident at your local emergency department tearing a strip off you if you "Diagnose" a patient....

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Scuba
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Postby Scuba » Sat May 26, 2007 11:05 am

I think that's what FireEMTGuy is saying... don't wait to make your own diagnosis... call EMS and get'em transported asap.


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FLASHOVER05
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Postby FLASHOVER05 » Sat May 26, 2007 11:56 am

Oops.... my badI think I missed the catch phrase

Noala
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scenario # 2

Postby Noala » Sat May 26, 2007 3:50 pm

Upon arrival, I would take over command and do a quick scene survey,ask all by standers to back up and if 911 has been called.Introduce myself to the patient even if she is unresponsive. Do abc"s while I ask first responder to get oxygen preped,and bp cuff ready.I would ask if the patient was witnessed falling and assume since it was in the middle of a field and no damage is likly occured to her spine,I would place patient in the supine position,making sure airway is clear,once patient is on 100% oxygen and breathing,I would perform a second more thorough search of the patient checking for any wounds , bleeding , and a medical alert bracelet while asking the bystanders if she has any allergies, especially to bee stings.While doing this the 3rd mfr is radioing dispatch with info and filling out a run report since this is really a 2 man/woman job.Ambulance is 4 minutes away so we continue to try get patient to respond by talking to her and reasurring her and take vitals again .Rembering to not give patient anything by mouth even if it is a hot day,we can moistened her lips with a clean wet cloth.

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dentedhead
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Postby dentedhead » Sat May 26, 2007 4:17 pm

Noala wrote:assume since it was in the middle of a field and no damage is likly occured to her spine,I would place patient in the supine

Except for the line drive she may have taken to the head,or the collision with another player or believe it or not falling wrong in a syncopal episode has been enough to cause c-spine injury.

Dentedhead
Thousand a week for hide and seek on call when Im paid to be.

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firefighter26
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Postby firefighter26 » Sat May 26, 2007 5:53 pm

Wow, I almost forgot about this thread!

Ok, how about another scenario.

You've been called out to the local petting zoo/farm for a shortness of breath call. An employee meets you up front and tells you that your PT is a 4 year old female over in the petting zoo area. She was standing behind a goat that was spooked and kicked up, hitting her and knocking her over very hard.

There is a large crowd around the PT, who you find sitting up and hunched over clutching her stomach still gasping for breath. You notice her lips are blue.

Mother is holder her and yelling for someone to help because her daughter 'can't breath'.

The father is being combative with a zoo/farm employee nearby and when he sees you and your crew starts to head over in your direction yelling at you aggressively to hurry up and do something.

EHS will be 10 minutes.
"No one ever called the fire department for doing something smart"
- Unknown

"If you don't like what you see, Why don't you fight it?
If you know there's something wrong, Why don't you right it?"
- Trooper

Noala
Posts: 2
Joined: Wed Dec 31, 1969 7:33 pm

4yr old @ the zoo

Postby Noala » Sat May 26, 2007 7:54 pm

do a quick scene survey making sure all wild animals are locked up.Introduce yourself etc etc .Obviously this little girl is in shock and considering how the injury occured,someone needs to maintain c-spine control probably from the front since she is on mom's lap.You don"t want to move her. If she got kicked in the head chances are there will be visible swelling.A cold compress applied to the area.Mom can hold this in place.If no bruising is visible,check for bruising around the eyes and ears. .She could have been kicked in the chest .check for a flail chest by looking for bruising around the area,laboured breathing.She could have been kicked in the abdomin,suffering from internal bleeding .Check airway and admin 100% oxygen take vitals.If patient vomits allow her to do so while still maintaining c-spine.Of course the paramedics have been called by now .Just keep checking child and reassuring mom.If dad has not calmed down even though your partner has assured you are doing everything you can possibly do ,call security or the police
Last edited by Noala on Sat May 26, 2007 8:02 pm, edited 1 time in total.


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