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Things That Make You Go Hmm Part 1ppt

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Shore EMS Conference 2010
Shore EMS Conference 2010

Abnormal Medical and Trauma Shore EMS Conference 2010

EducaciónSalud y medicina
1 de 132
Things That Make You Go Hmm… Unusual EMS Sean M. Elwell, EMT, RN Injury Prevention Coordinator Trauma Program Alfred I.duPont Hospital for Children Wilmington, DE
About Me… ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Alfred I. duPont Hospital for Children ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Delaware Trauma Level Designation LEVEL I  A regional resource trauma center able to care for all trauma patients LEVEL II  Regional trauma center able to provide care to all patients. May need to transfer out depending on resources available LEVEL III  Provides for initial care of all trauma patients arranging for transfer for those requiring resources of a Level I or II Trauma Center LEVEL IV  A participating hospital that is an acute care facility which transfers trauma patients with moderate or severe injuries to Trauma Center after initial resuscitation. Not Designated  
Trauma Alert Criteria: Stable ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Trauma Code Criteria: Unstable ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
New Jersey EMS… Captain Chief President All EMS and Rescue Operations All Fire Suppression Operations All Executive Operations EMS Chain of Command: Captain, Lieutenant, Chief, Deputy Chief
A Review
Back to Basics-Primary Survey ,[object Object],[object Object],[object Object],[object Object]
Primary Survey Steps ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Back to Basics-Secondary Survey ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Secondary Survey ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Case Studies
By The Way… ,[object Object]
Case 1…
Dispatch ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What are your initial reactions? ,[object Object]
Scene Size-Up ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Upon Arrival
Now What? ,[object Object],[object Object],[object Object]
Plan of Action ,[object Object],[object Object],[object Object],[object Object],[object Object]
Extrication Dilemmas ,[object Object],[object Object],[object Object],[object Object],[object Object]
C-Spine ,[object Object]
Proper Collar Sizing ,[object Object]
Things to Remember ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Primary Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Extrication Complete
Secondary Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Transport Decisions ,[object Object],[object Object],[object Object],[object Object]
Patient Outcome
Compression Injury ,[object Object],[object Object]
Paraplegia ,[object Object],[object Object]
Case 2…
Dispatch ,[object Object],[object Object],[object Object],[object Object]
What are your initial reactions? What are your initial reactions? Scene Size Up Starts at Dispatch
Upon Arrival ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Femoral Artery
Bike Accident X
Bike Accident
Primary Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Secondary Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
BLS Actions ,[object Object],[object Object],[object Object]
Rescue Arrival ,[object Object],[object Object],[object Object]
 
Next… ,[object Object],[object Object],[object Object]
Patient Outcome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What if? ,[object Object],[object Object],[object Object],[object Object]
Femoral artery was severed? ,[object Object],[object Object]
Bleeding was uncontrolled?
Patient was unresponsive? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Other potential injuries? ,[object Object],[object Object],[object Object]
Case 3…
Dispatch ,[object Object],[object Object],[object Object]
What are your initial reactions? What are your initial reactions? Scene Size Up Starts at Dispatch
Upon Arrival ,[object Object],[object Object],[object Object],[object Object]
Primary Assessment ,[object Object],[object Object],[object Object],[object Object]
Does this patient meet alert or code criteria?
Secondary Assessment ,[object Object],[object Object],[object Object],[object Object]
Interventions ,[object Object],[object Object],[object Object],[object Object]
Oxygen Delivery ,[object Object],[object Object],[object Object]
Oral Airway ,[object Object],[object Object],[object Object],[object Object]
Nasal Airway ,[object Object],[object Object],[object Object],[object Object],[object Object]
Transport Decisions ,[object Object],[object Object],[object Object],[object Object]
What is Shock? ,[object Object]
Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Signs of Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment for Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
 
Patient Outcome ,[object Object],[object Object],[object Object],[object Object]
Open Maxillary Fracture ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Treatment ,[object Object],[object Object],[object Object],[object Object]
In The End… ,[object Object],[object Object],[object Object]
Case 4…
Dispatch ,[object Object],[object Object],[object Object],[object Object],[object Object]
What are your initial reactions? What are your initial reactions? Scene Size Up Starts at Dispatch
Arrival
Findings ,[object Object],[object Object],[object Object],[object Object]
Level of Consciousness? ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Primary Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Secondary Assessment Secondary Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Injuries ,[object Object],[object Object],[object Object]
Interventions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Open Fracture
Put Bone Back In? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pain Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
RICE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Transport Decisions ,[object Object],[object Object],[object Object],[object Object],[object Object]
Arrival to ED ,[object Object],[object Object],[object Object]
Injuries
Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Outcome ,[object Object],[object Object],[object Object],[object Object]
Case 5…
Dispatch ,[object Object],[object Object],[object Object]
What are your initial reactions? What are your initial reactions? Scene Size Up Starts at Dispatch
Upon Arrival ,[object Object],[object Object],[object Object]
Concerns ,[object Object],[object Object],[object Object]
Primary Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Secondary Assessment Secondary Assessment Secondary Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Neurological Assessment ,[object Object],[object Object],[object Object],[object Object]
Pencil Stabilization ,[object Object],[object Object]
Transport Decisions ,[object Object],[object Object]
Arrival at Emergency Department ,[object Object],[object Object]
Pencil Through Nose
Now the Real Pictures
Findings ,[object Object]
Ethmoid Sinus ,[object Object],[object Object],[object Object],[object Object],[object Object]
Pneumocephaly ,[object Object],[object Object],[object Object]
Management ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Outcome ,[object Object],[object Object],[object Object],[object Object],[object Object]
Case 6…
Dispatch ,[object Object],[object Object],[object Object]
Where Are We Going? ,[object Object],[object Object],[object Object]
What are your initial reactions? Scene Size Up Starts at Dispatch
Upon Arrival ,[object Object],[object Object],[object Object],[object Object],[object Object]
Patient Contact ,[object Object],[object Object],[object Object],[object Object]
Primary Assessment ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Secondary Assessment
Injuries Noted ,[object Object],[object Object],[object Object],[object Object],[object Object]
Management ,[object Object],[object Object],[object Object],[object Object]
Transport Decisions ,[object Object],[object Object],[object Object],[object Object]
What About the Driver ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
What do you think?
Huffing ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Huffing Management ,[object Object],[object Object],[object Object],[object Object],[object Object]
Critical Thinking ,[object Object],[object Object],[object Object]
Back to our 6 Year Old ,[object Object],[object Object],[object Object],[object Object]
Arrival at ED ,[object Object],[object Object],[object Object]
CT Scan
Outcome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
When Can I Return to Play? ,[object Object],[object Object],[object Object],[object Object],[object Object]
Summary

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  • 1. Things That Make You Go Hmm… Unusual EMS Sean M. Elwell, EMT, RN Injury Prevention Coordinator Trauma Program Alfred I.duPont Hospital for Children Wilmington, DE
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  • 5. Delaware Trauma Level Designation LEVEL I  A regional resource trauma center able to care for all trauma patients LEVEL II  Regional trauma center able to provide care to all patients. May need to transfer out depending on resources available LEVEL III  Provides for initial care of all trauma patients arranging for transfer for those requiring resources of a Level I or II Trauma Center LEVEL IV  A participating hospital that is an acute care facility which transfers trauma patients with moderate or severe injuries to Trauma Center after initial resuscitation. Not Designated  
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  • 8. New Jersey EMS… Captain Chief President All EMS and Rescue Operations All Fire Suppression Operations All Executive Operations EMS Chain of Command: Captain, Lieutenant, Chief, Deputy Chief
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  • 36. What are your initial reactions? What are your initial reactions? Scene Size Up Starts at Dispatch
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  • 55. What are your initial reactions? What are your initial reactions? Scene Size Up Starts at Dispatch
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  • 58. Does this patient meet alert or code criteria?
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  • 76. What are your initial reactions? What are your initial reactions? Scene Size Up Starts at Dispatch
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  • 95. What are your initial reactions? What are your initial reactions? Scene Size Up Starts at Dispatch
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  • 105. Now the Real Pictures
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  • 123. What do you think?
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