Delegate your partner to immobilize the object using a log cabin type dressing. This needs to be delegated as soon as it is found.
The only time it is acceptable to remove the impaled object is if it is causing an away obstruction or if it is interfering with the proper hand placement for performing CPR, Prior to removing the object the EMR should consult with online medical control for direction
With a through and through impalement, alternate transportation position may be required (do the best you can).
Critical interventions for Deadly Bleeding?
Delegate a partner to control the bleeding with direct pressure as soon as you find cut about the bleed. If there is C-spine considerations delegate C-spine control first, then control the bleeding
a) Direct pressure
b) Pressure point
c) Pressure dressing
e) And, ONLY IF NOT CONTROLLED BY THE FIRST 4, a tourniquet may be considered (preferably) with online medical direction permission,
Once you fix the problem you should change your gloves and finish the rapid wet check.
If MOI indicates C-Spine, always call C-Spine!
Critical interventions for Fractured and dislocations?
As soon as you identify any potential fracture or dislocation in either your patient overview or primary survey you should:
1. Delegate a partner to manual immobilize the area. Do not splint on scene with a critical patient, manual immobilize only. Splint after assessing the area in the secondary (en route to hospital).
2. If no distal circulation on the potentially fractured limb, the EMR should realign to anatomical position in an attempt to restore circulation immediately after confirming the absence of circulation. There is only 1 realigning attempt made in the field.
3. Never attempt to realign any fracture that can include a joint, if it does involve the joint immobilize only, It is cut of scope for EMR'S to reduce dislocations.
4. EMRs do not apply traction to fractures. A traction splint is used for mid-shaft femur fractures, in this case the tractions splint is applying the traction. The end points of a traction splint are:
- 10% of the patients body weight
- Max of 15 lbs of traction (if you are using a bilateral traction splint the max is still 15 lbs)
definition of ICP/Cushinq's triad?
a triad of vital signs that are caused by the development of ICP in either a trauma or medical cause.
Hypertension: a blood pressure that is increasing, often over 180 systolic
Bradycardia: a head rate that is decreasing, often 60 BPM or lower
Cheyne stakes breathing: deep and irregular breathing pattern
Unequal sized pupils
Critical interventions for ICP/Cushinq's triad?
hyperoxygenate: the patient using a BVM with a 02 flow rate of 15 L/min making sure the reservoir bag is never less then 2/3 full,
ventilating: 1 breath every 3 seconds or 20/min.
If on a backboard: the head end should be elevated 15-20 degrees, if not on a board, elevate the head end of the stretcher 15-20 degrees
Definition of Flail chest?
2 or more ribs are broken in 2 or more places.
Critical interventions for Flail chest?
Hand stabilize the flail segment
Delegate you partner to apply a bulky dressing and tape it towards the head and feet.
Never encircle the chest.
Critical interventions for Sucking chest wound?
Seal the sucking chest wound with your gloved hand
Delegate your partner to cover the sucking chest wound with an occlusive dressing taped on 3 sides with the open side down.
Critical interventions for Eviscerated organs?
Cover the eviscerated organs with a moist sterile dressing
Cover the dressing with an occlusive dressing taped on all 4 sides
Cover the patient with a blanket
Critical interventions for Fractured Pelvis?
Use a scoop stretcher with padding (blankets) on both sides of the pelvis and on top of the pelvis
Strap them to the scoop, shoulder to hip, shoulder to hip, hip to knee, hip to knee, followed by head blocks, taping the patients head down using a star pattern across the forehead and one under the chin.
patient must then be secured by at least 3 straps to a back board, the reason for this is that most medical directors do not consider a scoop stretcher to be spinal motion restriction, The patient is then moved to a wheeled stretcher, secured to the stretcher with the 3 straps.