Scenario 2.   You're sitting around at an event on a Saturday enjoying the company of some friends you haven't seen for awhile. You're CiC for this event but its been quiet all day. All around you there are activities taking place. From where you are you can smell the feast cooking in the kitchen. There are tables full of people engaging in games or some A&S activities. You know that other rooms at the event site are being used for some armoured combat, rapier combat and there was even space left over for some classes.   Suddenly you hear someone yelling for a chirugeon. Getting up you head to the yelling and are met a few steps from your table by a gentlemen who states, "They've cut themself. You have to hurry. It's really bad. There's blood everywhere!"   1. What do you do first? Ask questions.. Who is cut? How Many Victims and were exactly are they??   2. What are you thinking? Is my belt/pocket kit big enough for this one or do I take the extra time to get something bigger or send someone else to get it? Any other chirurgeons around that can back me?   3. How do you approach this incident? Controlled haste.. No sence panicking the populace seeing a Chirurgeon fly through the hall like a mad man. Assess situation mentally.. what location is the injured person in? Do I know ahead of time of any possible source/cause of the injury (what activities were happening in that room etc.)? Do I need to take any added precautions for my own safety going in? Due to the mention of blood I would probably be starting to glove up or at least getting them out ready for what I may see on entry.     When you arrive at the classroom you see about 10 people all crowded around someone sitting on a chair. When you finally make your way through to the casualty you see a middle-aged gentleman (approx. 40 yrs old) who is currently holding his forearm and hand close to his chest with what appears to be a white veil wrapped around his arm. You do notice blood on the veil. You notice that there is blood on the floor at his feet as well as some on his tunic.    1. What is your first assessment? What are you looking for? General appearance of the victim, his actions and ability to breath and converse properly etc. indications of confusion or possible shock etc. any indications of added problems other than an obvious wound someplace either on an arm or possibly chest?  Attempt to guesstimate the quantity of blood on scene as an indication of the size or severity of the wound and any pottential for victim to become faint, unconcious or shocky. What caused the injury? Did anyone witness it?   2. What is your second assessment? What are you looking for? Vitals of victim for indications of shock or loss of circulation to the wounded extremity and any need for more than just first aid at this time and activation of 9-1-1 if required. Examination of the wound to determine severity and required treatment etc.     3. How do you control this scene? Clear out un needed spectators as best possible. Ask for a couple of helpers to (a) be ready to help steady the victim in his chair in case he does faint or loose conciousness or to move him should the need arrise. (b)advise 9-1-1 and any other needed help (autocrat etc. back up first aid)if or as required. (c) control access to the room so other curious onlookers dont become a problem and for the comfort and privacy of the victim.

 

Percival

---

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On the second #1 question, I'd also add get Consent. Just because your
called does not mean you can take over. Ask before doing anything else.

Russ / Dafydd


>
>
>
>
>         Scenario 2.
>
>         You're sitting around at an event on a Saturday enjoying the
> company of some friends you haven't seen for awhile. You're CiC
> for this event but its been quiet all day. All around you there
> are activities taking place. From where you are you can smell the
> feast cooking in the kitchen. There are tables full of people
> engaging in games or some A&S activities. You know that other
> rooms at the event site are being used for some armoured combat,
> rapier combat and there was even space left over for some classes.
>
>         Suddenly you hear someone yelling for a chirugeon. Getting up you
> head to the yelling and are met a few steps from your table by a
> gentlemen who states, "They've cut themself. You have to hurry.
> It's really bad. There's blood everywhere!"
>
>         1. What do you do first?
>         Ask questions.. Who is cut? How Many Victims and were exactly are
> they??
>
>         2. What are you thinking?
>         Is my belt/pocket kit big enough for this one or do I take the
> extra time to get something bigger or send someone else to get it?
> Any other chirurgeons around that can back me?
>
>         3. How do you approach this incident?
>         Controlled haste.. No sence panicking the populace seeing a
> Chirurgeon fly through the hall like a mad man. Assess situation
> mentally.. what location is the injured person in? Do I know ahead
> of time of any possible source/cause of the injury (what
> activities were happening in that room etc.)? Do I need to take
> any added precautions for my own safety going in? Due to the
> mention of blood I would probably be starting to glove up or at
> least getting them out ready for what I may see on entry.
>
>         When you arrive at the classroom you see about 10 people all
> crowded around someone sitting on a chair. When you finally make
> your way through to the casualty you see a middle-aged gentleman
> (approx. 40 yrs old) who is currently holding his forearm and hand
> close to his chest with what appears to be a white veil wrapped
> around his arm. You do notice blood on the veil. You notice that
> there is blood on the floor at his feet as well as some on his
> tunic.
>
>         1. What is your first assessment? What are you looking for?
>         General appearance of the victim, his actions and ability to
> breath and converse properly etc. indications of confusion or
> possible shock etc. any indications of added problems other than
> an obvious wound someplace either on an arm or possibly chest?
> Attempt to guesstimate the quantity of blood on scene as an
> indication of the size or severity of the wound and any pottential
> for victim to become faint, unconcious or shocky. What caused the
> injury? Did anyone witness it?
>
>         2. What is your second assessment? What are you looking for?
>         Vitals of victim for indications of shock or loss of circulation
> to the wounded extremity and any need for more than just first aid
> at this time and activation of 9-1-1 if required. Examination of
> the wound to determine severity and required treatment etc.
>
>
>         3. How do you control this scene?
>         Clear out un needed spectators as best possible. Ask for a couple
> of helpers to (a) be ready to help steady the victim in his chair
> in case he does faint or loose conciousness or to move him should
> the need arrise. (b)advise 9-1-1 and any other needed help
> (autocrat etc. back up first aid)if or as required. (c) control
> access to the room so other curious onlookers dont become a
> problem and for the comfort and privacy of the victim.
>
>
>   Percival
>
>
> ------------------------------------------------------------------------------
>   Looking for the perfect gift? Give the gift of Flickr!
>

I agree- I've been called over by someone only to be told by the injured person
that I'm not needed.
Medb

--- On Wed, 2/11/09, sheldon@... <sheldon@...> wrote:

From: sheldon@... <sheldon@...>
Subject: Re: [E-Chir] Scenario 2; part 1
To: E-Chir@yahoogroups.com
Date: Wednesday, February 11, 2009, 5:25 PM


On the second #1 question, I'd also add get Consent. Just because your
called does not mean you can take over. Ask before doing anything else.

Russ / Dafydd

----- Original Message -----

From: Jackie Wyatt

To: E-Chir@yahoogroups.com

Sent: Wednesday, February 11, 2009 12:38 PM

Subject: Re: [E-Chir] Scenario 2; part 1

I agree- I've been called over by someone only to be told by the injured person that I'm not needed.
Medb

--- On Wed, 2/11/09, sheldon@pipcom.com <sheldon@pipcom.com> wrote:

From: sheldon@pipcom.com <sheldon@pipcom.com>
Subject: Re: [E-Chir] Scenario 2; part 1
To: E-Chir@yahoogroups.com
Date: Wednesday, February 11, 2009, 5:25 PM

On the second #1 question, I'd also add get Consent. Just because your
called does not mean you can take over. Ask before doing anything else.

Russ / Dafydd

Brian Goodheart's responses:

> Suddenly you hear someone yelling for a chirugeon. Getting up you
head to the yelling and are met a few steps from your table by a
gentlemen who states, "They've cut themself. You have to hurry. It's
really bad. There's blood everywhere!"
>  
> 1. What do you do first?

Get up carefully from what I was doing.
Make sure my mini-kit is on my belt.

>  
> 2. What are you thinking?

Mentally reviewing contents of my mini-kit.

Wondering who is the Chirurgeon in Charge and the Autocrat.

Also who has a cell phone in case it is needed.

Also... are there chirurgeons with more medical qualifications than
myself? Xristina our Kingdom Chirurgeon for instance (and its not
kissing ass, its looking for superior skills for the benefit of the
patient) or Baroness Margaret a nurse.

>  
> 3. How do you approach this incident?
>  

First look for signs of ongoing risk to myself or others.
Crowd control and cessation of near by activities may be called for.


> When you arrive at the classroom you see about 10 people all
crowded around someone sitting on a chair. When you finally make
your way through to the casualty you see a middle-aged gentleman
(approx. 40 yrs old) who is currently holding his forearm and hand
close to his chest with what appears to be a white veil wrapped
around his arm. You do notice blood on the veil. You notice that
there is blood on the floor at his feet as well as some on his
tunic. 
>  
> 1. What is your first assessment? What are you looking for?

Airway, Breathing, Circulation. Is their brain getting oxygen via
blood.
Is the patient talking? That's a good sign.


>  
> 2. What is your second assessment? What are you looking for?

Is there an imbeded object?
Is there risk of new injuries from a stray object?


>  
> 3. How do you control this scene?
>

First instruct people to give him room to breath.

Ask the patient what happened.

Ask someone to look for the Autocrat and something to clean the
floor with.

Keep an eye on the bleeding for the volume of blood loss
and "spurting" which would indicate an artery is cut.

Put on the gloves from my mini-kit.

Recommend to the patient that he goto emergency.


Question: Should we be calling 911 to ready profesional transport
rather (ambulance)?

The patient talking to you largely completes the critical assessment
of ABC.

I would add take a moment before departing on their "no" to see if
they are likely to pass out. Once they pass out... uh... the
assessment changes to potentially life threatening and consent is
assumed.

Brian the Green


--- In E-Chir@yahoogroups.com, Jackie Wyatt <jkwyatt@...> wrote:
>
> I agree- I've been called over by someone only to be told by the
injured person that I'm not needed.
> Medb
>
> --- On Wed, 2/11/09, sheldon@... <sheldon@...> wrote:
>
> From: sheldon@... <sheldon@...>
> Subject: Re: [E-Chir] Scenario 2; part 1
> To: E-Chir@yahoogroups.com
> Date: Wednesday, February 11, 2009, 5:25 PM
>
>
> On the second #1 question, I'd also add get Consent. Just because
your
> called does not mean you can take over. Ask before doing anything
else.
>
> Russ / Dafydd
>

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At 07:53 AM 2/17/2009, you wrote:
>Your primary assessment reveals that your casualty is breathing a
>bit shallow but he does not appear to be in any significant
>respiratory distress. He does appear to be a bit pale. Your
>secondary assessment reveals a large laceration starting mid-palm,
>pinky finger side and extending at a slight angle down the forearm
>for about 10 cm. It is still bleeding but does not appear to be
>obviously spurting. When asked the gentleman states that his name is
>Dave and he was trying to loosen a tight knot in the leather he was
>working on with a knife when his blade slipped and caught his arm.
>
>1. How do you treat this injury?
>2. What questions could you be asking?

"Dave, are you usually this pale when you injure yourself?"  ask with
a mixture of concern and teasing and a smile.  Some people just react
strongly to the sight blood, need to know how he reacts.

Put gloves on

First I want to wash it, but if he's looking shaky already he
probably can't come to the bathroom with me.  I'll ask him if he'd
feel more comfortable reclining on the floor, and point out that if
we raised his feet it would help him feel better.  Send a couple of
the bystanders to look for pillows and something washable in case he
drips on it, and another for a feast box or something to raise his feet.

Ask Dave if he has any allergies to soaps, or anything else.  Ask
another bystander to get two bowls with warm water, one with a bit of
soap in it.

Wash the wound, using some gauze pads and the water, looking for
signs of how deep it is, and how wide it's spreading.  Rinse with
clean water, pat dry, cover with clean gauze and wrap to hold gauze
in place and apply pressure.  (I guess I'm assuming that the bleeding
is slow and basically cleans up.)

Also want to find out if he has particular friends at the event with
him, whom he came with, and send a bystander to get at least one of
these people.

>You notice as you're questioning Dave that he starts to answer you
>more slowly and seems to be having some trouble keeping his head up.
>Checking his bandages you notice that the bleeding doesn't seem to
>have stopped and he has bled through your dressing.
>
>3. What do you do now?

Discretely get a bystander to call 911, someone who looks intelligent
and preferably a local who knows where we are and how to give
directions.  I'm discrete because I don't want him to argue with me,
but since his level of consciousness is getting worse (especially if
he's reclining/lying down) then he needs more care than I am qualified for.

Then I'll talk to him about the wound, point out that it's still
bleeding and he doesn't seem to be feeling well, and that I think he
should go to the hospital.  What he says back and how he says it,
will help me monitor his level of consciousness.  I'd also apply more
pressure to the wound, possibly with some extra hands to help.  Ask
him how he's feeling overall as well.  Start looking for further
injuries that could be making this more complicated.

>4. What should you be thinking?

I should make more notes on what I found, what I've done, and his
vital signs.  I can't interpret vital signs well, but I can give the
information to the paramedics.

>5. What are the signs/symptoms of shock?

Pale, shallow breathing, cold, clammy skin.  Answering more slowly,
and trouble keeping his head up, sounds worse than just shock.  And
shock can be serious as well, if it's severe.

Eyrny
currently lapsed chirurgeon

 

Your primary assessment reveals that your casualty is breathing a bit shallow but he does not appear to be in any significant respiratory distress. He does appear to be a bit pale. Your secondary assessment reveals a large laceration starting mid-palm, pinky finger side and extending at a slight angle down the forearm for about 10 cm. It is still bleeding but does not appear to be obviously spurting. When asked the gentleman states that his name is Dave and he was trying to loosen a tight knot in the leather he was working on with a knife when his blade slipped and caught his arm.     1. How do you treat this injury?   Signs of shock are already making themselves known so I would start by having 9-1-1 notified if they have not been already or updating them as to the status (may mean an increased responce code for more urgent attendance) have someone check to see if there are any more skilled chirurgeons (possibly with medical skills) present and have them sent for and begin to treat victim for shock by having asistance in getting him into a reclined position and having his legs slightly elevated, get some warm blankets or other coverings that can be placed over those parts of the victim not being treated. Treat victim for bleeding with bandages and direct pressure to wound. Cleaning of the area would be an option at this time but as this seems to be going the hospital route they will be sterilizing the area anyhow so it would be a judgment call based on distance to a hospital and time frames involved etc.   2. What questions could you be asking?   Any prior medical conditions (check for medic alert etc.) to be aware of (past heart or other long term medical conditions or medications in use that could effect things or make things go downhill fast). Keep asking how victim is feeling to monitor both his general condition and if he is starting to fall further into shock etc. and allow you to measure level of conciousness. Ask about friends/family at the event that can be contacted to both aid in your treatment and knowledge of victim plus to allow them a heads up they will need to attend hospital etc. with the victim or make plans to have his property secured and taken care of in his absence.           You notice as you're questioning Dave that he starts to answer you more slowly and seems to be having some trouble keeping his head up. Checking his bandages you notice that the bleeding doesn't seem to have stopped and he has bled through your dressing.   3. What do you do now?   Update 9-1-1 with deterioratiing situation of victims conciousness and continued blood loss. Re bandage over original bandages to try and control bleeding. Continue to treat for shock with blankets etc. and keep victim calm and as still as possible.     4. What should you be thinking?     Keeping the situation under control. Keep patient calm as well as the bystanders etc. Do a "Just In Case" check to Make sure additional supplies are availible such as more bandages and CPR supplies etc. Is there a Defibrulator availible in the facility (only in the case of someone trained in their use) Prep for ambulance arrival and keeping crowds back to allow easy access, Keep victim talking to keep them awake and conciouse as much as possible.   5. What are the signs/symptoms of shock?   shallow or rapid breathing-irregular breathing cold clamy skin or possibly sweaty skin weekness confusion or aparent drowsiness leeding to eventual loss of conciousness rapid week pulse   Percival

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--- In E-Chir@yahoogroups.com, Ninka <dyscordant_rose@...> wrote:
>
> Your primary assessment reveals that your casualty is breathing a
bit shallow but he does not appear to be in any significant
respiratory distress. He does appear to be a bit pale. Your
secondary assessment reveals a large laceration starting mid-palm,
pinky finger side and extending at a slight angle down the forearm
for about 10 cm. It is still bleeding but does not appear to
be obviously spurting. When asked the gentleman states that his name
is Dave and he was trying to loosen a tight knot in the leather he
was working on with a knife when his blade slipped and caught his
arm.  
>  
> 1. How do you treat this injury?
>  

10 cm is like 2/3 of a foot... a good length of the forearm.

Consider it as a potential major blood loss and arrange for 911 to
be called. (They have blood and plasma, I dont and cant use it
anyway).

Put my gloves on.

Lower the patient to the ground to reduce gravity's affect on
getting blood to the brain.

Use the gauze padds from my mini-kit on exposed wound or overtop of
the existing bandage. (believing it better to leave the existing in
place which already should be aiding blood clotting)

Preferably patient is to apply pressure to the dressings.

Have the injury elevated. (gravity will slow the blood flow)

> 2. What questions could you be asking?
>  

Where is the knife now?

Is there anything inside the wound?

Who are you here with?

Who can get another chirurgeon (preferably the higher skilled ones)?

Who can find my car to get the larger aid supplies?


>  
>  
>  
>
> You notice as you're questioning Dave that he starts to answer you
more slowly and seems to be having some trouble keeping his head up.
Checking his bandages you notice that the bleeding doesn't seem to
have stopped and he has bled through your dressing.
>  
> 3. What do you do now?

Having gone unconscious from blood donation myself recoganize this
is the start of fainting. The brain is not getting enough oxygen. An
automatic reaction is to get the brain low, in the case of fainting
that means falling.

Make sure he is laying down. This avoids him getting falling
injuries.

Get assistance in keeping the wound elevated. He wont be able to
keep doing it.

Prop up the legs so that blood will drain down toward the all
important brain.

Ask him if he knows his blood type.

Update 911 with the change in condition.

Assign someone to do crowd control to clear up more room. The
paramedics will need it.

Assign someone to meet the paramedics and lead them in.

Apply more dressings, tieing tightly. This may include sacrificing
the mini-kit pouch itself as a bandage. Ask for permission to cut up
his garb for more dressings or for others to volunteer material.

Repeat sending someone for other chirurgeons or supplies. Inform
them to interrupt ANY activity including court and tell the other
chirugeon it is becoming an "ABC" from bleeding.

Ask him again who is his emergency contact.

Advise he really needs to goto the hospital. Ask his permission for
transport by paramedics.

If someone is available notifty the Autocrat.

Also if the Kingdom Chirurgeon is present at the event notify them
(must be done within 24 hours of emergency services being on site
(yes???) )


>  
> 4. What should you be thinking?  

If blood loss continues the "C" of ABC will fail. Even if I do CPR
there may not be enough blood to move the oxygen around.

Time frame on the brain is 4 minutes from end of oxygen but he is
several minutes from that to bleed out. The paramedics should likely
be here by then.

A vein (returning blood, non-squirting) has likely been cut. A major
vein will take time to stop bleeding but may yet stop on its own.
Still he needs to goto a hospital.

>  
> 5. What are the signs/symptoms of shock?
>

Inability to get oxygen to the brain which can include:
- pale skin colour (loss of the colour red from the missing blood)
- dizziness (as the brain begins to malfunction)
- difficulty speakin (as the brain begins to malfunction)
- cold feel to the body (lack of heat from oxygen being burned)

I believe there is also shivering (from trying to make heat from
muscle activity) and sweating.

>
>
__________________________________________________________________
> Yahoo! Canada Toolbar: Search from anywhere on the web, and
bookmark your favourite sites. Download it now at
> http://ca.toolbar.yahoo.com.
>

>
> 10 cm is like 2/3 of a foot... a good length of the forearm.
>
> Consider it as a potential major blood loss and arrange for 911 to
> be called. (They have blood and plasma, I dont and cant use it
> anyway).
>
> Put my gloves on.
>

etc etc

Forgot to say b1laxson is me Brian Goodheart aka the Green Guy

and recalling my own experience fainting on doing a blood donation
(1st time, not other times I did it)... man... I got alot of varied
experience as a patient. ^_^

Brian the Green here (1st aid cert)

There was mention in one response about Defibrilators and those
trained in them.

It would be good for a brief review of the different types of the
Defibs.


The original designs did indeed need qualifications in their use.
Some of the newer ones still do.

However there are ones that dont. IIRC these are P.A.D. for Public
Access Defibrilator. These are meant for even non-1st-aiders to use.
They are appearing in places like malls and some buildings with alot
of seniors.

>NOT< all defibs though are P.A.D.

If it is not then it is supposed to be secured, like behind a
secuirty desk or in an office.


IT would be good know if there is a defib at a site whether it is
P.A.D. or not.

I would appreaciate if Xristina (or other higher cert) can confirm
or correct my above statements.

Brian the Green

I will be there. Though I am fighting and also on duty with His Excellency
Septentria that day.

Brian the Green
Chiropractor found a new bone to move for the first time! (YEEARRRGGG)



--- In E-Chir@yahoogroups.com, StFursto@... wrote:
>
>
>
>
> Greetings to all Ealdormere's and visiting Chirurgeons.
>
> ???? Our beloved Dame Tsivia has known for a bit that I'm unable to attend
Winter War as I'm out of the country... I truely wish I could be there to meet
with people but hope that everyone has a wonderful time and that Dame Tsivia's
elevation is a truely grand affair - I will be there in spirit!!
>
> Best wishes,
> Fursto
>

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Winter War was alot of fun.

I only sat in on a portion of the meeting and presume in good order there will
be a relay by the higher-than-I folks as to any official things we need to know
about it.

B the G
Happily typing with both arms.

----- Original Message -----

From: Ninka

To: e-chir@yahoogroups.com

Sent: Tuesday, April 21, 2009 11:17 PM

Subject: [E-Chir] certification request (need for Coronation)

Greetings everyone, I am trying to get a warrant roster signed at Coronation this upcoming weekend so if you haven't already sent your certifications in then please do so ASAP. I need the following; Your name SCA name Certification level and exp CPR exp SCA membership and expiry chirugeonate level (chirugeon-in-training, chirugeon or mentor). I am sure that there are more chirugeon's out there than the 10 people that I have already received info from. This will be the only roster signed before Pennsic. For any of you planning to go this roster will help streamline the sign in at the first aid point at War. If you have any questions please feel free to contact me. In service, Xristina

---

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Afraid I'll only be in attendance for one day, and teaching 2 classes at
that...so I'm probably not the best choice. HOORAH For them for thinking
of it however: dance events are often more injury-plagued than fighting
ones <twisted ankles>...

TSivia


> Greetings everyone,
>  
> I have been asked  by Emma Dansmeyla if there would be any chirugeon
> attending the Knowne World Dance Symposium who would be willing to work as
> the chirugeon-in-charge for the event. The event is on the weekend of the
> 2nd -5th of July (the same weekend as War of the Trillium) and is being
> held at McMaster University (which has a hospital on-site).  They are not
> required to have a chirugeon on site but if anyone was interested and
> attending the event please feel free to contact Emma at the following
> email address; sarah.scroggie@...
>  
> In service,
> Xristina
>  
>  
>
>
>       __________________________________________________________________
> Be smarter than spam. See how smart SpamGuard is at giving junk email the
> boot with the All-new Yahoo! Mail.  Click on Options in Mail and switch to
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Need to make sure I do this right:

Looking at my card its dated 22Jun08 for Standard First Aid & CPR C by Heartsafe

There isnt an expiry date printed on it.

IIRC this to be renewed once a year by taking a CPR C recert course?

Err... missed the date but some can renew if its close? If not I'll have to take
the full course again.

Looking to do it in the Toronto Area. Leads to suitable people would be great.

In looking around some of the Toronto based ones state their certs are good for
three (3) years not one (1). So Im a little confused and wish to check if I need
to do the renewal this year or not.

An example 3 year cert is:
http://www.torontocpr.com/re_standard.aspx

Brian the Green
Green like the expired foods in a fridge

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