New Case - Page 2

Heretic · 03-09-2008, 21:11

How would I handle this?
Initial: From my understanding he moved to cover on his own. Insure the rest of the “team” is pulling security, returning an ass kicking and are not injured. There are no advanced treatments in the “field”. There is only life saving treatments. Always remember A-B-C. That will save more lives then hemostatic dressings. No difficulty in breathing = good so far. Keep the guy talking! If he is talking to you he is breathing for you. Constant reassessment of Airway and breathing. Good visual inspection of the chest. Head to toe blood sweep (as always). I would refrain from using an occlusive dressing on the wound. 2x2 gauze taped in place, more for blood and to keep stuff out. Would you use a NPA? Would you intubate? No, for me on both. NPA, no good. PT now has two airways and the NPA would not be affective if the wound became the primary airway. ET tube without seeing the xrays I would not intubate. You cannot visualize the underlying trauma in the neck. I would treat it like a kid with epiglottis. Would I immobilize the c-spine? I carry a c-collar in my aid bag. That usually sits in a vehicle or a helo. My medical fanny pack doesn’t have room for it. Worry about the c-spine if time permits clear the c-spine. Once back in a vehicle or on the evac bird stress the c-spine. I would refrain from using the entrance wound for any type of airway. Looking at the anatomy the wound is superior to the vocal cords. Your chances of inserting your adjunct correctly are slim. I would hold off on the cric until the PT was distressed for air. Again all this cause the lack of knowledge in the underlying trauma.

I would not allow PT to stay in the fight. Yes he is stable (he can breathe) that is conditional right now. You do not know how long he will be able to maintain that airway. You have to keep in mind that you have extra injuries to the tissue from the round. Tissue swelling may be a factor. Evac time is a factor as well. That is all I have right now.

Red Flag 1 · 03-10-2008, 06:41

Heretic.

Is "NPA" nasopharyngel airway??

RF 1

Heretic · 03-10-2008, 07:27

Roger that.

Red Flag 1 · 03-10-2008, 11:26

Heretic,

That's what I thought. As an old anesthesia guy, I think your plan is pretty spot on! I really like the "kick ass" part that is seldom mentioned. There is a rule that says, " a chest that rises and falls means only that the chest rises and falls"; it does not mean the patient is exchanging gasses. Endotracheal intubation is an intervention that provides complete airway control. The tough part is doing so with judgement and skill...it seems you have the judgement part in your aid bag. I really like your looking at this as a case of epiglottitis...very mature insight! Well done 18D!!!

The only thing I could add is that if I have an airway problem, personal or professional, I'd like you to be in the area.

RF 1

Heretic · 03-10-2008, 13:48

Thank you! Every once in awhile it all comes back.