Quote:
Originally Posted by Brush Okie
No go on the sodium bicarb without labs. The body can tolerate acidosis better than alkalosis.
Also other drugs on board not known ie meth, heroin etc etc. You never really know for sure.
Why the Dextran? He needs a MD and good chance he will loose the leg. Notice the bleeding is minimal from the photo so the vessels may have already closed off from bleeding on the leg. Unknown internal injuries. I know the military is pushing the blood expander but again it may open up the wounds and cause more blood loss in the long run. If he is hypovolimic more fluid without the red blood cells does not help carry O2.
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Disagree on Na Bicarb. Don't have time to wait for labs. Patient already in the Compensatory stage (stage 2) shock. An ampoule of bicarb in 1 L of IV won't push patient into alkalosis.
Other major concern: Patient is asthmatic. Need to have Theophyline ready.
My assessment: Patient has already lost 2+ L of blood. Bleeding is controlled by the excellent response of Scamilton. Leg immobilized. Moved out of stream bed and up to vehicle for transport and pick up. IVs started. Physical assessment does not show signs of internal bleed (didn't fall far enough, leg took the brunt of force, bad PLF form
) or other life threatening injury. Possible head injury. Watch for bilateral pupil response. Can't treat this anyway. Dextran - yes (blood expander). O2 started. All efforts should be directed towards preventing the progression of shock. Next crisis is respiratory - likely. I am anticipating the need for the IV Theo.