Thread: EMT-B question

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    Default EMT-B question

    I arrived on a scene of a roll over and the driver had been ejected, they had a severe laceration to the upper thigh that had intestines coming out. I checked for a pulse and got nothing, there were no resperations, the pt was still warm but no vitals with a major trauma. We did not proceed to work the pt and I'm kind of wondering if I should have tried covering the laceration with salene soaked bandages and proceeded to start CPR. This is my first fatality and I just want to see if others agree on how things went down or if I should have worked the pt.

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    Son, you did just fine. But if you are wondering, you really should talk to your supervisor. Or consult your local protocall
    Courage, Being Scared to Death and Saddling Up anyways.

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    It sounds like you did right. Like Bushwhacker said, check with your supervisor about your local protocols. Due to immediately available local resources, some agencies may work something that a rural agency may not. If life signs were viable (which they weren't), it sounds like you had the right interventions set up.

    If you need to talk, talk to a close friend or ask about your local EAP. Good luck.

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    I would think that most jurisdictions would not work the patient. Trauma arrests or if the patient has "injuries incompatible with life" mostly do not get worked....at least here in my region

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    Thanks for the replies guys, kind of puts my mind at ease!

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    Yes, I'm sure most places would not start CPR on a patient like that. If you have a question, check with your supervisor but I'm sure you did just fine. Remember from your class where they mention risk the limb for the life? The worst problem he had was his heart was not pumping and he was not breathing. That is the most life threatening over the laceration with guts hanging out. There is only so much you can do and with that situation, there really isn't much anyone could do, from an EMT basic all the way up to a doctor. Patient's that code from trauma have a very slim survival rate.

    Even if you were there and watched the crash happen and rushed to his side immediately, I'm sure there was nothing that could be done.
    Last edited by Dickey; 01-17-2010 at 09:09 PM.
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    Quote Originally Posted by Dickey View Post
    ...from an EMT basic all the way up to a doctor. Patient's that code from trauma have a very slim survival rate.

    Even if you were there and watched the crash happen and rushed to his side immediately, I'm sure there was nothing that could be done.
    We Literally just talked about this tonight, A patient in that situation has a .04% chance that they will ever Leave a hospital in anything but a bag.
    Courage, Being Scared to Death and Saddling Up anyways.

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    That patient probably died from the injuries you couldn't see.

    Remember, that the deceleration injuries to the large blood vessels (like the aorta) cause a shearing and lacerations to large organs cause most of these cases to be lost before the 911 call is placed.

    Sounds like a rough call. I'm sure you did fine.

    You never forget your first one as an EMT. I'll never forget little details about mine.

    Don't dwell on it and if you can't shake it, talk to someone you trust down at the firehouse.
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    Quote Originally Posted by FireEMT712 View Post
    they had a severe laceration to the upper thigh that had intestines coming out.
    If they had intestines protruding from their thigh, then chances are they were DOA, just considering the amount of damage to other internal organs that would've caused this to happen. I've never heard of that before.

    Nonetheless, if you followed your protocols, I'm sure you did the right thing. I'm sorry you had to see that, but I respect your actions. Well done, bro.

    Take care

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    Quote Originally Posted by sweetpete View Post
    If they had intestines protruding from their thigh, then chances are they were DOA, just considering the amount of damage to other internal organs that would've caused this to happen. I've never heard of that before.

    Nonetheless, if you followed your protocols, I'm sure you did the right thing. I'm sorry you had to see that, but I respect your actions. Well done, bro.

    Take care
    That's my thoughts; if there were intestines coming out of a laceration on the thigh then there's a LOT of internal damage you're not seeing.

    Especially if you're fairly new, calling someone deceased at the scene is hard. This is particularly true if they're a younger person. We are there to "save lives" and it's a blow if we dont' at least try. However, the reality is that there are a number of lives we aren't going to save. This is one of those.

    If you're having trouble with this situation, talk to your supervisor about it. I'm sure you followed SOG's, as they all should have criteria for what to work and what not to, even if it's just leaving it to the discretion of the care provider.

    If you still have issues, particular second-guessing yourself or guilt, get with your department about arranging a CISD session. Don't wait thinking you can work through it, do it ASAP. There's nothing wrong with doing CISD and there's a reason it's offered. It doesn't make you any weaker than anyone else to accept help dealing with something like that.

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    So far I'd add more but it's seems a lot of my fellow brothers and sister have sumed it up.

    Only thing I would have you think about is... You thought about "I should have tried covering the laceration with salene soaked bandages and proceeded to start CPR," My thinking is...With the amount of injuries (and i agree with all the other statements made on here about unseen injuries), CPR wouldn't do much for the pt. 1.) you wouldn't be continuing flow to the brain w/ all the exits the blood has to go, even w/ a salene soaked bandage. You would be pushing the remaining blood out of the body. just my thinking. Sounds like you did fine. If you have questions ask your supervisor and see local protocols. Also if you are having issues further, ask for a CISM (CISD). It's a big help.
    "Courage is the resistance to fear, the mastery of fear, not the lack of fear." Mark Twain
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    I'll basically agree w/everything everyone said, they said it great. I'll just add that in this area, protocol now states that any pt found by EMS to be pulseless due to traumatic injury is not worked at all. This is even w/out something as major as a you mention. If someone was in a car that rolled over, was ejected, and had no cuts or bruises, same outcome. It goes back to that 0.04% someone mentioned earlier.

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    Quote Originally Posted by FireEMT712 View Post
    I arrived on a scene of a roll over and the driver had been ejected, they had a severe laceration to the upper thigh that had intestines coming out. I checked for a pulse and got nothing, there were no resperations, the pt was still warm but no vitals with a major trauma. We did not proceed to work the pt and I'm kind of wondering if I should have tried covering the laceration with salene soaked bandages and proceeded to start CPR. This is my first fatality and I just want to see if others agree on how things went down or if I should have worked the pt.
    You did fine bro. That's a hard call to deal with. Like the other brothers and sisters have said, if you need help you can always go to your fellow Firefighter/EMS workers and talk with them. Don't let it get you down. I know what it is like to lose a patient and it can be difficult, but you did all you could do.

    Take care bro. I'm sure your going to be a great medic. Stay at it.

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    Default Thanks!

    Thank you for all the replies guys I appreciate it, as far as thinking about it and "second guessing" myself, I wasn't as much second guessing myself as much as just wondering if anyone might have done anything different. I like to think about all my medicals over and over just kind of picking at myself if i can to improve things for the next call. Like my first possible stroke call I was focusing a lot on face and speech and motor response and I over looked a recently operated on wrist that could have definately passed a clot but when i thought over it again I put the pieces together and now for the next stroke call I will take that into consideration. I don't know if you guys might think this is unhealthy at all but for me it doesn't get me down at all but actually serves as a relief knowing I will do better on the next call of the same sort!

    And the biggest reason I was asking if anyone would work the pt was because the spouse showed up on scene and I kept checking for a pulse about ever 5 minutes so that the spouse did not think we were doing nothing. I mean it's not much I just can't imagine showing up on scene to my spouse and seeing people just standing around or walking around not doing anything for her.

    Again thank you all for the comments and the concern! This call didn't affect me but I'm sure there will be plenty that will, possibly the first pt i work and lose or something but DOA I can handle apparently!

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