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Scenario 2: part 2

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  • Ninka
    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
    Message 1 of 6 , Feb 17 4:53 AM
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      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?
       
       
       
       
      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?
       
      4. What should you be thinking?  
       
      5. What are the signs/symptoms of shock?


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    • Kathleen Gormanshaw
      ... 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
      Message 2 of 6 , Feb 17 7:26 AM
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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
      • Keith Crawley
        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
        Message 3 of 6 , Feb 17 11:33 AM
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          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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        • b1laxson
          ... 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
          Message 4 of 6 , Feb 18 1:34 PM
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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.

            >
            >
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          • b1laxson
            ... 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
            Message 5 of 6 , Feb 18 1:37 PM
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              >
              > 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. ^_^
            • tudorpot@gmail.com
              10 cm is equal to 4 inches 1 inch = 2.3 cm Freda
              Message 6 of 6 , Feb 18 3:44 PM
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                10 cm is equal to 4 inches      1 inch = 2.3 cm

                Freda
                 
                On Feb 18, 2009, at 4:34 PM, b1laxson wrote:


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

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