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Re: [E-Chir] Scenario 3

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  • Jackie Wyatt
    ... I have a Coleman lantern that is run on batteries and has more of a white light- something like that would make viewing the injuries easier than with a
    Message 1 of 9 , Dec 2, 2009
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      >I'd like ideas on getting appropriate light for reviewing the injuries.
       
      I have a Coleman lantern that is run on batteries and has more of a white light- something like that would make viewing the injuries easier than with a standard flashlight (for that matter, I think one of my flashlights is an LED one as well).
       
      I have to agree about not calling 911 for first degree burns and a sprained ankle- I'd be more likely to suggest that one of the patient's friends take him to a hospital to get checked out.

      Medb

    • viscountessk@rogers.com
      A and B are ok, don t forget C. I would do a quick check for the quality of the pulse and of the skin colour and condition. I d be interested in assessing the
      Message 2 of 9 , Dec 2, 2009
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        A and B are ok, don't forget C. I would do a quick check for the quality of the pulse and of the skin colour and condition.

        I'd be interested in assessing the ankle more closely while keeping it immobile. For example how is the circulation? Palpate the area very carefully. Crepitus? Deformities? Discolouration? How are the strength, sensation and mobility?

        Perhaps a moist cool sterile dressing lightly over the burned areas would help with the pain. Burns HURT! :) ok, I'm a wuss. But would also help treat for shock.

        Sprains also can hurt sometimes worse than breaks. Again, I'm a wuss. Did I mention that earlier?

        Given the results of the assessment of the ankle and the area covered by the burns and the possibility that the arm may be 2nd degree, I would probably call 911 as well. Daffyd you make a good very good point, but I'm a fan of erring on the side of caution. If the ankle assessment turns out well though, and there are no signs of shock, POV could also be an option.

        Kaellyn





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        -----Original Message-----
        From: sheldon@...
        Date: Wed, 2 Dec 2009 11:45:41
        To: <E-Chir@yahoogroups.com>
        Subject: Re: [E-Chir] Re: Scenario 3

        Greetings,

        Don't take this the wrong way, your very thorough, but you'd call for an
        Ambulance for first degree burns and a sprained ankle? As a former
        ambulance driver, I'd be a little turned off about that and would the
        person hurt really want to get saddled with the ambulance bill?

        Russ / Dafydd

        > Scenario 3 Response
        >
        > Brian the Green
        >
        > Check:
        > Approaching the scene look for:
        > = is the fire now behaving normally (which is mentioned in the scenario
        > that it is)?
        > = is there signs of sparks or smouldering on things nearby, such as hot
        > ash on the top of tents?
        > = Is there the glittering of broken glass?
        > = Is the patient talking? (I will assume for the rest of this that he is)
        > = Note the amount of wood and where it is.
        >
        > Call:
        > = Ask if someone here has a cell phone in case we need 911. If none here
        > task someone to find one and return with it.
        >
        > Care:
        > = Instruct the people to give ground so the patient can be safely
        > examined.
        > = Ask for who in the camp is looking after the fire. Advise them for
        > safety reasons to check on the fire and also to see if hot ash landed on
        > tents or other things nearby.
        >
        > = Approaching the patient ask where are the injuries.
        > = Instruct the patient to move farther back from the fire. Observe if they
        > are able to do so safely.
        > = Assessment showing that he is awake (as the arm is being clutched) and
        > talking (assumed for this response). This signals the ABC are okay.
        > = Beginning the secondary assessment the patient is found as (assumed for
        > this response) to have light burns on his right hand. The hair on the arm
        > is singed and the skin appears discoloured. No blistering has occurred.
        > = The left ankle is also hurting him significantly. Asking him to try
        > moving it finds he is unwilling due to pain.
        >
        >
        > = When the cell phone becomes available call 911. Instructing them that we
        > need an ambulance. There appears to be first degree burns to the right
        > hand and forearm. There is also an injured ankle. Give directions to the
        > event include the fire number/address of the site. Advise them it is a
        > camping site.
        > = Discuss with the operator if they wish us to leave the patient in the
        > camp or whether we should move them to the parking lot.
        > = If they are not sure it is better to leave the patient in the camp.
        > = If relocation is agreed a camp chair should be easily found which
        > several people could use to carry him out without needing to use his leg.
        > = In either case task someone to go to the end of the driveway with a
        > flashlight to guide the ambulance into the site and if need be to the
        > patient.
        >
        > Prepare for transport:
        > = Counsel the patient that it is best for the burns to be checked out
        > professionally at the hospital. For safety the ambulance should do the
        > transport so that they can care for the hand.
        > = Ask the patient if there is someone who can drive to the hospital to
        > bring them back.
        > = Also ask the patient if there is someone he would like us to contact for
        > him.
        >
        > Very Important:
        > = When the ambulance comes ask them which hospital they are going to!
        >
        > = Prepare notes to send the Kingdom Chirugeon regarding emergency services
        > being on site. Relay this information ASAP by email, phone etc.
        >
        >
        > Related Discussion:
        >
        > Big fires and tents:
        > There was a flashing surge from the fire. Tall flames can carry ash up
        > high enough that the wind can scatter it. Might be a few feet or a few
        > tens of feet. It is not unusual for camps have tents within 30ft of their
        > firepit and most have tents within 60ft.
        > I recall one event when to many pallets where burned at once. This is when
        > this important lesson was learned. One person did spot the smouldering
        > happening on their tent's awning. Those with tents nearby did a check and
        > shaking off smouldering bits.
        > While there are safety requirements in some parts of the world for fire
        > resistant tents those coatings can become worn with age. A large enough
        > heat could overcome the coating and set the tent on fire.
        > A particular danger for smouldering is that they might produce heat for
        > hours. Usually this is not going to happen with light ash from a flashing
        > fire. Still it is important to check. Thus it is possible for the tent to
        > have people sleeping in it when it catches fire hours later.
        > The ash can also burn a small hole in a tent without starting a fire.
        > Holes do not keep out rain very well at all.
        >
        > Dealing with too much fuel on a fire:
        >
        > a) Put out some of the fire
        > b) Put the whole fire out
        > c) Remove the fuel
        >
        > The safest way to deal with excessive wood (fuel) on a fire is to put the
        > whole fire out. Camps should have some means of putting the fire out
        > nearby. Water or dirt are usually available. A challenge with the
        > excessive fuel scenario is that the people who do that generally did not
        > think ahead… thus if, big if, they have something it likely isn't enough
        > for the now oversized fire.
        > With the big fire that had happened the excessive fuel was removed by
        > myself. Im trying to recall if we doused at least part of the fire first
        > and/or whether they simply didn't have enough water to put out the fire.
        > It wasn't obvious to those nearby in the darkness but the gloves I had on
        > are actually welder's gloves with a heat resistance. A stick/board was
        > used to get a pallet close to the edge. From there, with the known to be
        > heat resistant welding gloves, I could lift the pallet clear of the fire.
        > Once in a clear spot the pallet could be safely doused, patted down etc.
        > Great care was taken while doing this including make sure the space behind
        > me was clear.
        > Putting the gloves in water also gives you some protection. The water
        > evaporation pulls away some of the heat. Recharge the water on the gloves
        > regularly. When the gloves feel hot stop to let the gloves cool
        > (preferably with more water).
        > Why not use the water directly… a mug of water will give you several
        > soakings on gloves compared to maybe dousing one log on the fire.
        > Reminder this was with done with welding gloves to stop the high flying
        > ash starting secondary fires on tents.
        > I did this knowing for certain they where welding gloved. Do not trust
        > non-welding nor period nor "unknown" gloves to do this.
        > Nor is this something to be as a regular activity. Rather it was a way of
        > keeping of the rest of the camp safe when an emergency developed.
        > The far better situation is for those having fires to plan ahead and have
        > sufficient fire fighting gear (water, dirt, extinguishers) on hand in the
        > first place.
        > (Yes, there is of course some question as to whether the gloves should
        > have been used at all. The real problem was to much wood on the fire AND
        > insufficient proper resources leading to the other tents starting to
        > smoulder. No it was not my camp… I wandered in to join the party.)
        >
        >
        >
        >
        >
        >
        > ------------------------------------
        >
        > Yahoo! Groups Links
        >
        >
        >
        >




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      • b1laxson
        ... What does POV stand for in this case? (presumably not Point-Of-View used in my computer games). Also... When calling 911... a) Will they discuss with you
        Message 3 of 9 , Dec 7, 2009
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          --- In E-Chir@yahoogroups.com, viscountessk@... wrote:
          > Given the results of the assessment of the ankle and the area covered by the burns and the possibility that the arm may be 2nd degree, I would probably call 911 as well. Daffyd you make a good very good point, but I'm a fan of erring on the side of caution. If the ankle assessment turns out well though, and there are no signs of shock, POV could also be an option.
          >
          > Kaellyn
          >

          What does POV stand for in this case? (presumably not Point-Of-View used in my computer games).

          Also...

          When calling 911...

          a) Will they discuss with you if the ambulance is really needed? Though I believe they kinda have to once you ask because if something goes wrong after that they are in a bad legal situation.

          b) If they come and passenger refuses to come (after their mucho influence) is there no charge?

          c) I posted prior to the injury details so was treating as serious enough. I have had some one go on about a sprained ankle only to find out later that they had actually snapped 2 of 3 tendons and if the last one had gone there foot would have been Kaput.
        • b1laxson
          ... A good question and answer. Most probably know that LED lights cast a blue-tinged light which will affect the colours your see. LED ones can cast alot more
          Message 4 of 9 , Dec 7, 2009
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            --- In E-Chir@yahoogroups.com, Jackie Wyatt <jkwyatt@...> wrote:
            >
            > >I'd like ideas on getting appropriate light for reviewing the injuries.
            >
            > I have a Coleman lantern that is run on batteries and has more of a white light- something like that would make viewing the injuries easier than with a standard flashlight (for that matter, I think one of my flashlights is an LED one as well).
            >

            A good question and answer.

            Most probably know that LED lights cast a blue-tinged light which will affect the colours your see. LED ones can cast alot more light as they consume far less power so are generally made with dozens of emittors.

            Hmmm... dont carry a flashlight in the chirugeon belt pouch but I do have one in another belt pouch. Had enough of having fun at camping events only to realize I was well away from my camp when it was dark.

            Brian the Green
          • viscountessk@rogers.com
            POV is privately owned vehicle ... Although my first reaction is usually point of view too. Kaellyn Sent from my BlackBerry® powered by Virgin Mobile. ...
            Message 5 of 9 , Dec 8, 2009
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              POV is privately owned vehicle ... Although my first reaction is usually point of view too.

              Kaellyn


              Sent from my BlackBerry® powered by Virgin Mobile.

              -----Original Message-----
              From: "b1laxson" <b1laxson@...>
              Date: Tue, 08 Dec 2009 00:07:28
              To: <E-Chir@yahoogroups.com>
              Subject: [E-Chir] Re: Scenario 3



              --- In E-Chir@yahoogroups.com, viscountessk@... wrote:
              > Given the results of the assessment of the ankle and the area covered by the burns and the possibility that the arm may be 2nd degree, I would probably call 911 as well. Daffyd you make a good very good point, but I'm a fan of erring on the side of caution. If the ankle assessment turns out well though, and there are no signs of shock, POV could also be an option.
              >
              > Kaellyn
              >

              What does POV stand for in this case? (presumably not Point-Of-View used in my computer games).

              Also...

              When calling 911...

              a) Will they discuss with you if the ambulance is really needed? Though I believe they kinda have to once you ask because if something goes wrong after that they are in a bad legal situation.

              b) If they come and passenger refuses to come (after their mucho influence) is there no charge?

              c) I posted prior to the injury details so was treating as serious enough. I have had some one go on about a sprained ankle only to find out later that they had actually snapped 2 of 3 tendons and if the last one had gone there foot would have been Kaput.









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