The height of the ladder is unimportant in your assessment as the patient may not have been at the top of the ladder when he fell.
All patient refusals must be an informed refusal and in writing. If you treat all three patients even though they refused you are guilty of battery.
Because you do not know what caused the patient to became unconscious, spinal precautions need to be taken.
When a projectile is traveling through space it is giving off energy as it pushes away the air molecules. When it impacts with human tissue, kinetic energy is transferred from the projectile to the tissue. When this projectile is a high velocity missile, the tissue which absorbs this energy transfer is often damaged but not disrupted enough to be permanently damaged.
The mechanism of injury transfers energy to the patient, causing a pattern of injury that is predictable. The way a patient is injured is referred to as the Mechanism of injury. For example, a frontal impact auto accident is considered a mechanism of injury. This allows the clinician to predict the type of injuries the patient may have and predict their response to treatment. Injury patterns can be predicted by looking at the mechanism of injury.
Scene safety must be the first order of business upon approaching the scene. If you are injured then you cannot help those you were called to help. In addition, you will now compound the incident since you are now a victim. Body substance isolation is important after you arrive at the scene and approach the patient (s). Once you find the patient, then Airway/C-spine control are the next steps.
A hematoma is a large collection of blood, caused by larger blood vessels being damaged. A hematoma often is located between layers of tissues. A contusion is generally a smaller collection of blood within tissue such as the dermis. A bruise is a generic term which is often used interchangeably between a contusion and a larger hematoma.
Direct pressure stops 90% of all bleeding and should be done first. If direct pressure does not work in the first minute or two, then digital pressure should be applied next. Next steps include elevation and finally a tourniquet for uncontrolled or excessive bleeding. Pressure dressings should only be used once bleeding has stopped.
Any time there is open skin over a fracture it is considered an open fracture. A greenstick is generally found in children whose bones have not fully ossified. Comminuted is a fracture resulting from extreme forces causing many smaller fractures at the site of the fracture.
An inhalation injury inferior to the glottis can result in wheezing and bronchospasm. An inhalation injury superior to the glottis can cause a hoarse voice and stridor. Inhalation of the byproducts of combustion can cause wheezing but this would still be classified as an inhalation injury to the lower airway.
The last part of immobilizing the arm fracture (or any suspected fracture for that matter), is the assessment of distal motor, sensory, and perfusion status. This is done to assure there was no additional trauma from the immobilization process, and to assure the splint was not put on incorrectly (for example an air splint inflated too high). If there is a loss in the motor, sensory, perfusion findings following immobilization, the paramedic should immediately reassess the splinting process and correct any errors.
Pericardial tamponade causes decreased cardiac output as seen by pale skin and hypotension. In addition, jugular vein distention may be seen along with a narrowed pulse pressure. Other signs and symptoms include tachycardia, respiratory difficulties, and cyanosis of the face, neck, and arms. With tension pneumothorax or a significant hemothorax, decreased or absent breath sounds will be present.
Treatment of a gunshot wound to the thorax would include taking necessary spinal precautions. The open wound should be covered with an occlusive dressing. The respiratory distress should be treated with high flow oxygen with consideration of positive pressure ventilation and possible intubation. In addition, an IV should be started for a fluid route if hypotension worsens. Rapid transport is indicated for pericardiocentesis and possible surgery.
Of the 4 choices, the patient with a laceration on her thigh has an isolated injury and can be effectively managed by a non-trauma center. The other 3 patients require a more thorough assessment and therefore should be evaluated at a trauma center.
Direct pressure and fluids are this patient's best chance for survival and prevention of decompensated shock. ALS should be activated to administer fluids as soon as possible.
Pain is generally the most obvious sign of a crush injury and tends to present earliest out of all of the other associated signs and symptoms.
