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Scenario 7; part 1

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  • Ninka
    You are currently stopping in at a local event that you had not planned on attending due to other outside commitments that day. However, you had promised a
    Message 1 of 9 , Oct 30, 2010
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      You are currently stopping in at a local event that you had not planned on attending due to other outside commitments that day. However, you had promised a friend that you'd be able to deliver an item to said event, so here you are. While you are tracking down your friend you hear a call for a chirugeon. Someone quickly looks to you and lets you know that no other chirugeon is at the event. You do not have your kit with you and its not in your car either (perhaps you're being driven around by a friend that day).
       
      You are told that the injured party is a 6 year old girl who's been accidently cut with a knife and the bleeding looks really bad.
       
      ********************************************
       
      Before I give more information for this scenario let's start a discussion here with a couple of questions. I'll post the next part of the scenario (actual victim and scene contact) in a week's time. That should give people a chance to answer/participate if they choose too.
       
      1) You do not have your kit. How will this impact what you do? Will this impact what you do?
       
      2) Given that the only information you currently have is that a child has been cut and the bleeding 'looks really bad', what sort of problems/issues do you think you should be anticipating? Should you be anticipating any problems?
       
      3)For any problems or issues that you've thought of (if any), how might you deal with them?
       
      Feel free to add any other questions or comments to this section. Don't feel limited to what my tired brain is coming up with at this point. :)
       
      Xristina

    • Kathleen Gormanshaw
      ... I d have the herald cry the site looking for a first aid kit. Many people carry them, especially in their cars. If the autocrat is handy, the site may
      Message 2 of 9 , Oct 31, 2010
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        On Sat, Oct 30, 2010 at 4:01 PM, Ninka <dyscordant_rose@...> wrote:
        >
        >
        > You are currently stopping in at a local event that you had not planned on attending due to other outside commitments that day. However, you had promised a friend that you'd be able to deliver an item to said event, so here you are. While you are tracking down your friend you hear a call for a chirugeon. Someone quickly looks to you and lets you know that no other chirugeon is at the event. You do not have your kit with you and its not in your car either (perhaps you're being driven around by a friend that day).
        >
        > You are told that the injured party is a 6 year old girl who's been accidently cut with a knife and the bleeding looks really bad.
        >
        > ********************************************
        >
        > 1) You do not have your kit. How will this impact what you do? Will this impact what you do?

        I'd have the herald cry the site looking for a first aid kit. Many
        people carry them, especially in their cars. If the autocrat is
        handy, the site may have a first aid kit as well.

        > 2) Given that the only information you currently have is that a child has been cut and the bleeding 'looks really bad', what sort of problems/issues do you think you should be anticipating? Should you be anticipating any problems?

        This past Trillium Wars a child was escorted past my camp by a gaggle
        of children, crying and dripping blood all over the place. It looked
        "really bad" but reality was a simple cut across the palm. Unless
        someone says "unconscious" I don't think "really bad" until I can
        clearly see the problem, and I wouldn't activate EMS without more
        information either.

        > 3)For any problems or issues that you've thought of (if any), how might you deal with them?

        My first thoughts are water to clean it up, where's the first aid kid,
        and where's the parent. I should really put the parent first in that
        list, but honestly I'm not going to think in that order. At Trilliums
        I was glad to have one of the other kids go find the parent, while I
        waylaid the messy one and started rinsing her off with drinking water.
        Our first aid kit was in the tent, but I don't remember if I ever put
        on the plastic gloves, which would have been a smart choice. 6 year
        olds aren't very risky for blood borne disease, but it's possible.

        If it was my 6 year old, I'd be happy to have someone else start
        reasonable first aid measures, and let me be the comfort giver
        instead.

        Funny, the kid at Trilliums WAS cut by a knife, though she tried to
        deny it and blame it on some wire they found. It was a nice sharp
        knife, with a clean looking cut, much better for her health than a
        rusty wire would be! A couple of the other kids weren't letting the
        lie stand though, and told her mother the truth. Rusty wire would
        have me wanting a better educated opinion much more than a simple
        knife.

        Eyrny
      • viscountessk@rogers.com
        On a related question, how many of us carry at the very least gloves around with us? I m pretty old school in that I certed first aid long before the emphasis
        Message 3 of 9 , Oct 31, 2010
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          On a related question, how many of us carry at the very least gloves around with us?

          I'm pretty old school in that I certed first aid long before the emphasis on contagen, but I now carry a set in a small plastic container in my purse

          Men would be at a disadvantage unless they're carrying a 'murse' ;) but would a pair fit in a wallet? I'm reminded of the old optimistic protection that young men are rumoured to carry.

          Kaellyn

          Sent from my BlackBerry® powered by Virgin Mobile.

          -----Original Message-----
          From: Kathleen Gormanshaw <kgormanshaw@...>
          Sender: E-Chir@yahoogroups.com
          Date: Sun, 31 Oct 2010 08:19:20
          To: <E-Chir@yahoogroups.com>
          Reply-To: E-Chir@yahoogroups.com
          Subject: Re: [E-Chir] Scenario 7; part 1

          On Sat, Oct 30, 2010 at 4:01 PM, Ninka <dyscordant_rose@...> wrote:
          >
          >
          > You are currently stopping in at a local event that you had not planned on attending due to other outside commitments that day. However, you had promised a friend that you'd be able to deliver an item to said event, so here you are. While you are tracking down your friend you hear a call for a chirugeon. Someone quickly looks to you and lets you know that no other chirugeon is at the event. You do not have your kit with you and its not in your car either (perhaps you're being driven around by a friend that day).
          >
          > You are told that the injured party is a 6 year old girl who's been accidently cut with a knife and the bleeding looks really bad.
          >
          > ********************************************
          >
          > 1) You do not have your kit. How will this impact what you do? Will this impact what you do?

          I'd have the herald cry the site looking for a first aid kit. Many
          people carry them, especially in their cars. If the autocrat is
          handy, the site may have a first aid kit as well.

          > 2) Given that the only information you currently have is that a child has been cut and the bleeding 'looks really bad', what sort of problems/issues do you think you should be anticipating? Should you be anticipating any problems?

          This past Trillium Wars a child was escorted past my camp by a gaggle
          of children, crying and dripping blood all over the place. It looked
          "really bad" but reality was a simple cut across the palm. Unless
          someone says "unconscious" I don't think "really bad" until I can
          clearly see the problem, and I wouldn't activate EMS without more
          information either.

          > 3)For any problems or issues that you've thought of (if any), how might you deal with them?

          My first thoughts are water to clean it up, where's the first aid kid,
          and where's the parent. I should really put the parent first in that
          list, but honestly I'm not going to think in that order. At Trilliums
          I was glad to have one of the other kids go find the parent, while I
          waylaid the messy one and started rinsing her off with drinking water.
          Our first aid kit was in the tent, but I don't remember if I ever put
          on the plastic gloves, which would have been a smart choice. 6 year
          olds aren't very risky for blood borne disease, but it's possible.

          If it was my 6 year old, I'd be happy to have someone else start
          reasonable first aid measures, and let me be the comfort giver
          instead.

          Funny, the kid at Trilliums WAS cut by a knife, though she tried to
          deny it and blame it on some wire they found. It was a nice sharp
          knife, with a clean looking cut, much better for her health than a
          rusty wire would be! A couple of the other kids weren't letting the
          lie stand though, and told her mother the truth. Rusty wire would
          have me wanting a better educated opinion much more than a simple
          knife.

          Eyrny


          ------------------------------------

          Yahoo! Groups Links
        • tsivia@uottawa.ca
          ... I always have in my purse a super-duper mini facemask which is about 1 1 2 square as a keychain, and a pair of gloves therein. ... And on Xristina s
          Message 4 of 9 , Oct 31, 2010
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            > On a related question, how many of us carry at the very least gloves
            > around with us?

            I always have in my purse a super-duper mini facemask which is about 1
            1'2" square as a keychain, and a pair of gloves therein.

            > Men would be at a disadvantage unless they're carrying a 'murse' ;) but
            > would a pair fit in a wallet? I'm reminded of the old optimistic
            > protection that young men are rumoured to carry.

            And on Xristina's scenario, all my alarm bells went off at the phrase "SIX
            YEAR OLD"... OH dear.

            TSivia


            > -----Original Message-----
            > From: Kathleen Gormanshaw <kgormanshaw@...>
            > Sender: E-Chir@yahoogroups.com
            > Date: Sun, 31 Oct 2010 08:19:20
            > To: <E-Chir@yahoogroups.com>
            > Reply-To: E-Chir@yahoogroups.com
            > Subject: Re: [E-Chir] Scenario 7; part 1
            >
            > On Sat, Oct 30, 2010 at 4:01 PM, Ninka <dyscordant_rose@...> wrote:
            >>
            >>
            >> You are currently stopping in at a local event that you had not planned
            >> on attending due to other outside commitments that day. However, you had
            >> promised a friend that you'd be able to deliver an item to said event,
            >> so here you are. While you are tracking down your friend you hear a call
            >> for a chirugeon. Someone quickly looks to you and lets you know that no
            >> other chirugeon is at the event. You do not have your kit with you and
            >> its not in your car either (perhaps you're being driven around by a
            >> friend that day).
            >>
            >> You are told that the injured party is a 6 year old girl who's been
            >> accidently cut with a knife and the bleeding looks really bad.
            >>
            >> ********************************************
            >>
            >> 1) You do not have your kit. How will this impact what you do? Will this
            >> impact what you do?
            >
            > I'd have the herald cry the site looking for a first aid kit. Many
            > people carry them, especially in their cars. If the autocrat is
            > handy, the site may have a first aid kit as well.
            >
            >> 2) Given that the only information you currently have is that a child
            >> has been cut and the bleeding 'looks really bad', what sort of
            >> problems/issues do you think you should be anticipating? Should you be
            >> anticipating any problems?
            >
            > This past Trillium Wars a child was escorted past my camp by a gaggle
            > of children, crying and dripping blood all over the place. It looked
            > "really bad" but reality was a simple cut across the palm. Unless
            > someone says "unconscious" I don't think "really bad" until I can
            > clearly see the problem, and I wouldn't activate EMS without more
            > information either.
            >
            >> 3)For any problems or issues that you've thought of (if any), how might
            >> you deal with them?
            >
            > My first thoughts are water to clean it up, where's the first aid kid,
            > and where's the parent. I should really put the parent first in that
            > list, but honestly I'm not going to think in that order. At Trilliums
            > I was glad to have one of the other kids go find the parent, while I
            > waylaid the messy one and started rinsing her off with drinking water.
            > Our first aid kit was in the tent, but I don't remember if I ever put
            > on the plastic gloves, which would have been a smart choice. 6 year
            > olds aren't very risky for blood borne disease, but it's possible.
            >
            > If it was my 6 year old, I'd be happy to have someone else start
            > reasonable first aid measures, and let me be the comfort giver
            > instead.
            >
            > Funny, the kid at Trilliums WAS cut by a knife, though she tried to
            > deny it and blame it on some wire they found. It was a nice sharp
            > knife, with a clean looking cut, much better for her health than a
            > rusty wire would be! A couple of the other kids weren't letting the
            > lie stand though, and told her mother the truth. Rusty wire would
            > have me wanting a better educated opinion much more than a simple
            > knife.
            >
            > Eyrny
            >
            >
            > ------------------------------------
            >
            > Yahoo! Groups Links
            >
            >
            >
            >
            >
            > ------------------------------------
            >
            > Yahoo! Groups Links
            >
            >
            >
            >
          • crawleys@sympatico.ca
            I have several little mask/glove combo carriers (keychain sized) and always have at least one on me someplace. To: E-Chir@yahoogroups.com From:
            Message 5 of 9 , Nov 1, 2010
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              I have several little mask/glove combo carriers (keychain sized) and always have at least one on me someplace.
               

              To: E-Chir@yahoogroups.com
              From: tsivia@...
              Date: Sun, 31 Oct 2010 23:39:31 -0400
              Subject: Re: [E-Chir] Scenario 7; part 1

               
              > On a related question, how many of us carry at the very least gloves
              > around with us?

              I always have in my purse a super-duper mini facemask which is about 1
              1'2" square as a keychain, and a pair of gloves therein.

              > Men would be at a disadvantage unless they're carrying a 'murse' ;) but
              > would a pair fit in a wallet? I'm reminded of the old optimistic
              > protection that young men are rumoured to carry.

              And on Xristina's scenario, all my alarm bells went off at the phrase "SIX
              YEAR OLD"... OH dear.

              TSivia

              > -----Original Message-----
              > From: Kathleen Gormanshaw <kgormanshaw@...>
              > Sender: E-Chir@yahoogroups.com
              > Date: Sun, 31 Oct 2010 08:19:20
              > To: <E-Chir@yahoogroups.com>
              > Reply-To: E-Chir@yahoogroups.com
              > Subject: Re: [E-Chir] Scenario 7; part 1
              >
              > On Sat, Oct 30, 2010 at 4:01 PM, Ninka <dyscordant_rose@...> wrote:
              >>
              >>
              >> You are currently stopping in at a local event that you had not planned
              >> on attending due to other outside commitments that day. However, you had
              >> promised a friend that you'd be able to deliver an item to said event,
              >> so here you are. While you are tracking down your friend you hear a call
              >> for a chirugeon. Someone quickly looks to you and lets you know that no
              >> other chirugeon is at the event. You do not have your kit with you and
              >> its not in your car either (perhaps you're being driven around by a
              >> friend that day).
              >>
              >> You are told that the injured party is a 6 year old girl who's been
              >> accidently cut with a knife and the bleeding looks really bad.
              >>
              >> ********************************************
              >>
              >> 1) You do not have your kit. How will this impact what you do? Will this
              >> impact what you do?
              >
              > I'd have the herald cry the site looking for a first aid kit. Many
              > people carry them, especially in their cars. If the autocrat is
              > handy, the site may have a first aid kit as well.
              >
              >> 2) Given that the only information you currently have is that a child
              >> has been cut and the bleeding 'looks really bad', what sort of
              >> problems/issues do you think you should be anticipating? Should you be
              >> anticipating any problems?
              >
              > This past Trillium Wars a child was escorted past my camp by a gaggle
              > of children, crying and dripping blood all over the place. It looked
              > "really bad" but reality was a simple cut across the palm. Unless
              > someone says "unconscious" I don't think "really bad" until I can
              > clearly see the problem, and I wouldn't activate EMS without more
              > information either.
              >
              >> 3)For any problems or issues that you've thought of (if any), how might
              >> you deal with them?
              >
              > My first thoughts are water to clean it up, where's the first aid kid,
              > and where's the parent. I should really put the parent first in that
              > list, but honestly I'm not going to think in that order. At Trilliums
              > I was glad to have one of the other kids go find the parent, while I
              > waylaid the messy one and started rinsing her off with drinking water.
              > Our first aid kit was in the tent, but I don't remember if I ever put
              > on the plastic gloves, which would have been a smart choice. 6 year
              > olds aren't very risky for blood borne disease, but it's possible.
              >
              > If it was my 6 year old, I'd be happy to have someone else start
              > reasonable first aid measures, and let me be the comfort giver
              > instead.
              >
              > Funny, the kid at Trilliums WAS cut by a knife, though she tried to
              > deny it and blame it on some wire they found. It was a nice sharp
              > knife, with a clean looking cut, much better for her health than a
              > rusty wire would be! A couple of the other kids weren't letting the
              > lie stand though, and told her mother the truth. Rusty wire would
              > have me wanting a better educated opinion much more than a simple
              > knife.
              >
              > Eyrny
              >
              >
              > ------------------------------------
              >
              > Yahoo! Groups Links
              >
              >
              >
              >
              >
              > ------------------------------------
              >
              > Yahoo! Groups Links
              >
              >
              >
              >


            • b1laxson
              ... Glory to the Belt Favour idea Tsivia promoted during her time as K-Chir. The belt favour I carry fits a few things yet is super portable enough not to
              Message 6 of 9 , Nov 1, 2010
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                --- In E-Chir@yahoogroups.com, viscountessk@... wrote:
                >
                > On a related question, how many of us carry at the very least gloves around with us?
                > Kaellyn
                >

                Glory to the Belt Favour idea Tsivia promoted during her time as K-Chir.

                The belt favour I carry fits a few things yet is super portable enough not to intfere with event life. The basic list being:
                - some sandwhich bags to hold the following
                - a few band aids
                - a simple respirator mask (if you can find them, I never did)
                - gloves! (one (or two) pair only in the mini kit)
                - a 4x4 gauze pad (the starter for any major bleeding)
                - some paper and a pen (for notes)

                that's about it.

                If you had to guess you could poke a hole in a sandwhich bag for a respirator mask. hmm, a plastic grocery bag would be a good idea for that to. Could use the grovery bag as a waterproof inner liner to the kit.

                Including doing abdominal thrusts (which take no gear) you have at least some response for:
                A = Airway (abdominal thrust, gloves to pull soemthing out)
                B = Breathing (sandwhich bag for a mask)
                C = circulation (your CPR to replace the heart pumping; for critical bleeding gauze and band aids and the cloth for bleeding)

                Pretty much all other situations can wait to get a response. Or... need specific medical supplies like allergy medication you can't really randomnly carry.


                The cloth of the favour itself is also an emergency dressing. the gauze pad is the sterile one to be in direct contact.


                Brian the Green
                Thanks Tsivia for this belt favour!
              • Bethoc (Lesley)
                Greetings unto the List!   Great answers so far...   1) You do not have your kit. How will this impact what you do? Will this impact what you do?   After
                Message 7 of 9 , Nov 1, 2010
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                  Greetings unto the List!
                   
                  Great answers so far...
                   
                  1) You do not have your kit. How will this impact what you do? Will this impact what you do?
                   
                  After initial securing the scene and assessment of ABCs, I'm going to determine how bad that bleeding is based on mechanism of injury, causative tool and location on the body. Is it spurting and bright red arterial? Is it slow and venous dark bleeding? Areas like the hands, head and feed are very vascularized to feed all the nerves there, so they can look like they are bleeding "a lot" without it being a very deep wound. Blood scares people; what appears to be a lot of blood scares them more.
                   
                  Sure, we can cry the hall for a first aid kit but, what if it's not handy? No gloves? No problem. Yes this child is 6 years old who isn't likely to have blood borne illnesses. However, I'm also protecting them from MY germs (to the open wound). So as long as it's not a huge venous bleed or an arterial bleed, I'd have the child press a clean hand with their own clean clothes or other cloth material onto the wound. Later, or if she is unable, I'd have the parent do it (who can handle their own child's blood as they see fit). Ideally, sterile or "medically clean" is the best, however, given what I see people putting on their wounds and how few of them actually turn into infections, I doubt that a clean cloth will cause much damage microscopically.
                   
                  Please note: tissues and papertowel break apart when wet so cloth is a more preferable improved alternative to gauze than tissues/papertowel. And baby powder should never EVER be put into a wound to stop bleeding (yes I've seen that too). Some naturapaths use moleskin to absorb blood but I'd be hesistant to use the fur of an animal with so much surface area directly on the wound.
                   
                  Of course, I also don't need a first aid kit to implement the primary treatment of RED = Rest Elevate and apply Direct pressure. so the child will sit, raise their hand to the shoulder and apply direct pressure to the palm herself (at least to start or until there is good infection control and/or first aid supplies).
                   
                  Barring a parent being able to hold the wound, or the child, and no gloves available, I'd use a very thick pad of cloths and my own clean bare and WASHED hands - most venous bleeding can be controlled with direct pressure in 10-15 minutes.
                   
                  2) Given that the only information you currently have is that a child has been cut and the bleeding 'looks really bad', what sort of problems/issues do you think you should be anticipating? Should you be anticipating any problems?
                   
                  as I mentioned earlier, what's the blood loss like? venous vs arterial? how much is lost?
                  are there deeper injuries such as tendons lacerated? are the edges approximated (able to come together)? what tissues can be seen inside the wound, if any? If the wound is large, deep or in a flexy-bendy area, stitches may be required, which would involve transport to an urgent care facility or local emergency (not all walk in clinics can stitch).
                  is the distal circulation present (i.e. the site most far away from the heart on the other side of the wounded area). I'd assess that through cap refill of the fingertips. Also a pulse check just to be sure of supply.
                  is the distal range of motion satisfactory? what about range of motion to the injured area (i.e. palm/wrist).
                   
                  Without the adequate first aid supplies, my primary concern would be ABCs, RED, and hold the wound edges together whilst applying pressure.
                   
                  3)For any problems or issues that you've thought of (if any), how might you deal with them?
                   
                  I'd also want to know if the child's vaccinations are up to date, for a thorough report to EMS although I can't do anything about it if they aren't.
                   
                  What was the child cutting? Wood? Metal? Food? are there any foreign bodies in the wound which need to be rinsed out or secured in place (if big). If it's a cut because of glass an xray may be in order to identify fragments in the wound.
                   
                  Are there any other injuries that were missed because of the concern over the visible injury? Is there a medical condition for which bleeding would be a problem (bleeding disorder, anemia, and if there's lots of blood loss conditions like diabetes for which homeostatsis could be altered). Will the child go into shock, faint or collapse at the sight of her own blood... will anyone else faint
                   
                  and always always always crowd control of well meaning watchers and helpers
                   
                  I could go on like this for hours.... heh heh heh
                   
                  happy reading!
                  Bethoc
                   
                   
                   


                   

                  ---
                   

                • Bethoc (Lesley)
                  whilst this is a good idea in theory, it does not actually provide you or your patient with true infection or barrier control. Airborne infection control
                  Message 8 of 9 , Nov 1, 2010
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                    whilst this is a good idea in theory, it does not actually provide you or your patient with true infection or barrier control. Airborne infection control requires a one way valve. A hole in a bag also cannot guarentee either droplet or solid materials moving between individuals. I wouldn`t recommended it because I doubt it would be supported as an appropriate (legal) first aid tool.
                     
                    The Heart and Stroke Foundation is actually promoting no ventilation CPR because of the number of trained people who would refrain from doing AR on someone they don`t know, even with the use of a barrier device.
                     
                    Just food for thought.
                     
                    Bethoc

                  • Bethoc (Lesley)
                    *snip* Airborne infection control requires a one way valve. *snip* really that should be one way valve with a TB or microbe filter....   Bethoc   *snip*
                    Message 9 of 9 , Nov 1, 2010
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                      *snip* Airborne infection control requires a one way valve. *snip*

                      really that should be one way valve with a TB or microbe filter....
                       
                      Bethoc
                       

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