sofmed
02-06-2008, 20:33
I am going to post a recent situational problem and how I handled it, then am going to sit back and soak up any information thrown my way.
As a medic in support of OIF, Detainee Ops at present, I am faced with running daily operations for our EVAC crew out of the TIF ER.
This is what happened recently...
Assault victim from detainee on detainee violence. Arrive at scene, have to enter actual caravan/living quarters as he's too beat up to carry to sally port. Guards clear area except for injured detainee.
Medic's worst nightmare...mulitiple injuries...lacerations about the head/face, arms, abdomen and legs, front and back, broken arms, bilaterally, humerous L arm, radial and ulnar fx's R arm. Legs...Left leg Femur and Fibula Fx, fibula was open fx; R leg only Tib/Fib closed fx's. Guy's been beaten about the head and shoulders with tent pole, so on top of lacs he has massive contusions and hematomas forming, seemingly everywhere.
Airway patent as he's screaming, start head to toe, C-spine control by one of the guards to start, then pressure and bandages on profuse bleeding, no flail chest or crepitous, abdomen sports a deep lac which requires bandaging immediately; pelvis stable, neg priopism, distal pulses intact all extremeties; once initial head to toe ocmplete, log roll carefully, back same as front...bruising, contusions, only minor lacs, nothing life threatening seen there.
Roll back down...begin secondary eval...Eyeballs intact (that's an issue here), PERRLA, airway still good, neg JVD/trach. deviation, lungs clear to auscultation and tympany, abdomen difficult to check at this point, but bleeding controlled to this point.
Skipping through some of the secondary to...lower extremeties...could do an anatomical splint, but for the multiple fx's the guy has. Would use the traction splint in my FLA but with a Femur AND open Fib fx on the same leg, and posing that he has present and strong distal pulses I nix on taking that route. Arms are sam splinted and wrapped with ace wraps...back to legs...now I'm out of splints...so here's where it gets tricky...the only thing I had within reach was three fruit boxes they carry daily supplies of fruit in with during meal times...very heavy corregated paper board boxes, very difficult to cut...I had no other materials to work with so I pulled out my J cutter and cut out a large rectangular section of the side of one box long enough to fit 2/3 of the L leg, scored it about 2 inches in from one end to the other on opposing sides and folded it to form a channel which I then slid under the affected leg...again ace wraps and kerlix saved the day. Performed the same steps with the right leg, while the other medic made a third check on other interventions, then we spine boarded him, litter loaded and truck loaded and transported. O2 enroute with only one vitals check available as ride to ER w/in 7 minutes. Unfortunately we're not authorized to EJ on the wire regardless of the situation or I'd have done one. Docs took care of that w/in first 5 mins on the gourney at ER.
I left out some of the interventions and such only to save space here. I am simply asking some of the QP medics to evaluate and suggest alternative tx angles I could have approached from, as I'm always about improving my skills. SurgicalCric is a dear friend and has seen me work. I'm simply asking for greater insight.
Thanks ahead of time for any advice. I'll be standing by.
Mick
As a medic in support of OIF, Detainee Ops at present, I am faced with running daily operations for our EVAC crew out of the TIF ER.
This is what happened recently...
Assault victim from detainee on detainee violence. Arrive at scene, have to enter actual caravan/living quarters as he's too beat up to carry to sally port. Guards clear area except for injured detainee.
Medic's worst nightmare...mulitiple injuries...lacerations about the head/face, arms, abdomen and legs, front and back, broken arms, bilaterally, humerous L arm, radial and ulnar fx's R arm. Legs...Left leg Femur and Fibula Fx, fibula was open fx; R leg only Tib/Fib closed fx's. Guy's been beaten about the head and shoulders with tent pole, so on top of lacs he has massive contusions and hematomas forming, seemingly everywhere.
Airway patent as he's screaming, start head to toe, C-spine control by one of the guards to start, then pressure and bandages on profuse bleeding, no flail chest or crepitous, abdomen sports a deep lac which requires bandaging immediately; pelvis stable, neg priopism, distal pulses intact all extremeties; once initial head to toe ocmplete, log roll carefully, back same as front...bruising, contusions, only minor lacs, nothing life threatening seen there.
Roll back down...begin secondary eval...Eyeballs intact (that's an issue here), PERRLA, airway still good, neg JVD/trach. deviation, lungs clear to auscultation and tympany, abdomen difficult to check at this point, but bleeding controlled to this point.
Skipping through some of the secondary to...lower extremeties...could do an anatomical splint, but for the multiple fx's the guy has. Would use the traction splint in my FLA but with a Femur AND open Fib fx on the same leg, and posing that he has present and strong distal pulses I nix on taking that route. Arms are sam splinted and wrapped with ace wraps...back to legs...now I'm out of splints...so here's where it gets tricky...the only thing I had within reach was three fruit boxes they carry daily supplies of fruit in with during meal times...very heavy corregated paper board boxes, very difficult to cut...I had no other materials to work with so I pulled out my J cutter and cut out a large rectangular section of the side of one box long enough to fit 2/3 of the L leg, scored it about 2 inches in from one end to the other on opposing sides and folded it to form a channel which I then slid under the affected leg...again ace wraps and kerlix saved the day. Performed the same steps with the right leg, while the other medic made a third check on other interventions, then we spine boarded him, litter loaded and truck loaded and transported. O2 enroute with only one vitals check available as ride to ER w/in 7 minutes. Unfortunately we're not authorized to EJ on the wire regardless of the situation or I'd have done one. Docs took care of that w/in first 5 mins on the gourney at ER.
I left out some of the interventions and such only to save space here. I am simply asking some of the QP medics to evaluate and suggest alternative tx angles I could have approached from, as I'm always about improving my skills. SurgicalCric is a dear friend and has seen me work. I'm simply asking for greater insight.
Thanks ahead of time for any advice. I'll be standing by.
Mick