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Re: [E-Chir] Scenario 2: part 2

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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 1 of 6 , Feb 17, 2009
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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 2 of 6 , Feb 17, 2009
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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 3 of 6 , Feb 18, 2009
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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 4 of 6 , Feb 18, 2009
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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 5 of 6 , Feb 18, 2009
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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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