Quote:
Originally Posted by Scamilton
TQ immediately on the leg. Have my buddy perform manual c-spine stabilization as I administer 15 lpm O2 by nasal cannula. Before we get him on a spine board, establish vascular access and begin with 1L NS fluid bolus.
Splint the leg with whatever is available. I would have an articulating splint ready that I would have made, and kept available on my rig. Pad with abdominal dressings to cover the exposed skin and keep it from moving within dead space of splint. Log roll the patient, check the back for any other trauma, place onto spine board. Secure to spine board, reassess splint and LOC. Make my first movement to helo LZ and reassess all vitals en route.
I would not worry about the arms if there was no signs of gross manipulation, and radial pulses are present. The ankle is the least of my worries, because this guy would prob lose the leg below the knee, and at the least lose most functionality.
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Very, very good initial response/treatment. However, I think this patient may already be in stage 2 shock (compensatory stage) i.e. hyperventilation, BP, pupil response (may be due to EtOH). Given the lag time to the hospital this patient could progress rapidly to irreversible shock. Concern: may be acidotic already. Consider an ampoule of Na bicarbonate in the IV. I would also push Dextran instead of NS.
Very interesting problem by the way. Not to be insensitive to the patient since he has the worst end of this deal.
