The Harley is still shiny, there isn't any major damage, there is a small pool of blood approximately 6 feet from where the patient is lying supine, C-spine being held by a passerby that happened to be from a local squad. First Response Squad members are surrounding the patient....
"Hi, Whats your name"
"Cindy"
"Cindy, What happened?"
"I don't know"
Judging by her facial expressions she knowns that something is out of the ordinary and she isn't in any pain, there is a small laceration that appears to be bleeding from her chin, she bit her lips, all her teeth are intact and her airway is clear, she has a helmet on, no visible deformities and major bleeds evident. Pressure is being held on a wound below her knee by a first responder. A rapid trauma assessment confirms what I already figured. The lac on her knee must be from something on the bike and the bones underneath appear to be intact.
She says her neck hurts, but its probably not neck-neck pain.
No allergies, takes an ACE inhibitor and birth control.
She goes on a board, and into the truck, off to the hospital.
Her pressure is slightly elevated, no signs or symptoms of cerebral hemorrhage.
I ask her numerous times if she is feeling nauseous.
18 gauge in her left AC.
Equal chest rise bilaterally, denies SOB, saturation at 100% on room air.
It was her first day riding, she had taken a safety course the previous weekend.
"If at first you don't succeed, don't try skydiving" goes through my head.
Curious, why did you start an IV on this pt?
ReplyDeleteShe was a Trauma patient.
ReplyDeleteDoes your system require you to start IV's on all trauma pt's?? As a basic I run trauma calls all the time that we don't need to gain IV access on...unless they need pain management or fluid therapy or have high potential for decompensation. Just wondered.
ReplyDeleteWould it be better to start an IV before any of those things you mention happen or would you rather wait for the patient to tank/decompensate before starting one?
ReplyDeleteWhy wouldn't you have started an IV in this instance?
It's just that based on what you described as mechanism combined with the pt's actual injuries, my index of suspicion that this pt is going to require an IV would be pretty low. I work for a busy ALS system and I would say that we end up starting IV's on maybe 15% of our "trauma" calls-if that. That being said, she was your pt and I was not there. I do think that there is a lot to be said for spidy-sense and if you thought that it was prudent to start an IV then I certainly respect that. I am only a lowly basic working my way through medic school anyway so take my comments with a grain of salt, I know just enough to be dangerous at this point. Good luck and keep up the good writing/world saving!:)
ReplyDelete