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256Re: [E-Chir] Scenario One

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  • Kathleen Gormanshaw
    Jan 6, 2009
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      At 10:29 PM 1/5/2009, you wrote:
      >Greetings everyone,
      >Here is the first of the training/discussion scenarios I was talking
      >about. I am starting off fairly simple in order to help everyone
      >become comfortable with the concept of these scenarios. As you will
      >see, I have given a description of the incident and then some
      >questions for you to answer. You are free to answer these questions
      >on this list or, if you are more comfortable, send them privately to
      >me. As discussion continues, I will add more questions as needed or,
      >if necessary, some answers. In some cases there are no right or
      >wrong answers. However, in some cases there are.
      >The purpose of these scenarios is to inspire discussion and to keep
      >our training percolating in our heads. Please remember that as
      >chirugeons we provide first aid. I am basing the treatments on Heart
      >& Stroke standards, as well as first aid standards.
      >If anyone has any questions please feel free to contact me and I
      >will do my best to answer you. Good luck and have fun with this.
      >In service,
      >Scenario 1.
      >You are sitting in your camp at War of the Trilliums enjoying a bit
      >of a break from the mid day heat and the event activities when you
      >hear a call for a chirugeon. Looking around you spot someone coming
      >up to you. They don't look panicked but they do look like they're in
      >a bit of a hurry. Spotting you they yell out that someone's been
      >hurt at the archery field and that you're needed. You grab your kit
      >and start making your way to the archery field.
      >1. What kind of things should you be thinking about at this point?

      Did someone get shot by an arrow? Where's a cell phone? How far is
      the archery field from the road? hmm This guy who found me isn't
      THAT panicked!

      >2. What do you think should be in your basic first aid kit?

      Bandaids to stop bleeding, splints to hold things in place, latex
      gloves, sugar, quarters, paper, pencil, air valve for rescue
      breathing. I'm sure there's more, hard to think of a list at once :-)

      >As you approach the archery field you see a group of 2-3 people
      >kneeling around someone sitting on the ground. They are sitting in
      >the open field but are behind the archery line by a good 15 feet.
      >Coming closer you see a male about 25-30 years of age sitting on the
      >field holding on to his left ankle. He is breathing normally. He
      >appears a bit flushed but you suspect that could be due to the
      >midday sun. When he sees you approach he grins up at you as he
      >explains that he wasn't paying attention to where he was walking and
      >stumbled into a hole in the ground and turned his ankle. He states
      >he tried to get up and did managed a couple of steps before the pain
      >got the better of him and he sat down again. When you look at the
      >ankle you see some minor swelling on the lateral side but no
      >bruising or deformities are noted. He states the pain is lessening
      >and his ankle movement is increasing as he rests.
      >3. As you get closer to the scene, what should you be looking for?

      Any other dangers around? Is the Archery Marshal still watching the
      archery field? Nothing else seems likely to be dangerous at this
      point, the archery field is rarely so near other activities that
      people would trip over us by accident.

      >4. Once you are at the casualty, what's the first thing you should
      >assess? How would you do that?

      Is he breathing well? If he's grinning at me and talking easily the
      answer is yes. Is there any chance of a brain injury? If his
      conversation makes sense, and there's no pain in his head, he's
      probably fine.
      Is he bleeding anywhere else? Ask him if it hurts anywhere else than
      the ankle. Make sure I can see the front of the leg where he would
      have banged it in the hole and ask him to lift up high enough to
      check the back of the leg.

      >5. What do you believe has happened to the casualty? How would you
      >determine that?

      As long as I can see the whole he stepped in, and the others around
      him aren't concerned about what he said, I'll believe his story. I'd
      like to see the hole, see how deep it is, and see how many steps
      there are to where he's sitting. Friends might have helped him move
      somewhere more comfortable though.

      >6. What kind of treatment would you give?

      I'd get him some ice and help him raise the ankle up so that his legs
      are flat, or his ankle up a little higher than his bum. I'd ask him
      to poke and prod and tell me where it seems to hurt the worst, if it
      looked like he missed any injured areas, I'd ask him to poke those
      and tell me how it felt. I'd clean and bandage any spots that were
      scraped and bleeding. I'd explain that I have only basic first aid
      training, and no experience with real ankle injuries. I can wrap it
      up so he can't damage it further and have someone help him to the
      hospital. He can arrange for some friends to take him, or an
      ambulance, but if the first check says breathing, bleeding, and
      brains are normal I don't think an ambulance is necessary. Or, he
      can ask around for someone who's familiar with ankles, get it wrapped
      up that way, and sit for the afternoon with it elevated. I'd explain
      that the ice should go on for 10 minutes then off for 10, repeating
      for the next few hours. If the ankle ever felt worse he should go to
      the ER, if it didn't feel much better by the next day he should go to
      the ER, if it didn't feel all better in a couple days he should go
      see his family doctor.

      My training says I should advise that he see a doctor right away, but
      his demeanour suggests that he probably doesn't think it's
      necessary. If he shows any sign of wanting an ER check, I'll
      encourage it. Otherwise, I'd rather he think I was reasonable, and
      would take the advice to go to the ER if it got worse, seriously. If
      it was my ankle, and it had started feeling better with just a few
      minutes of rest, I wouldn't have gone to the ER either.

      started first aid training to be a life guard 20 years ago, for the
      last 10 years or so Red Cross Standard First Aid. Currently lapsed
      in certifications.
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