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#5598 - 06/20/05 10:14 PM

Call discussion

Tammy Mezayek
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M22 was called out for a priority 2 injury at the lake. Upon arrival we were met by first responders as well as an off duty paramedic (from another system) and given a full report of a 23 y/o male who was struck from the side to the left rib/abdomen by a jet-ski. Patient got back on his watercraft, drove it to the shore and was assisted to the tailgate of the truck by the by-standers. No LOC.

Pt presents sitting 'indian-style' but doubled over with his head in his lap screaming with intense pain, and complaining of severe respiratory distress. Pt has a NRB on and is guarding his rib cage and abdomen. Pt is immobolized and re-assessed, found to have clear = bilateral lung sounds both upper and lower, but continues guard, scream with pain and complain of severe respiratory distress.

A discussion with the driver of the other jet ski reveals that he was traveling 'wide open' (for those of us with out jet-ski acceleration knowlege, that is 30+ mph) when he struck the patient. The call for Starflight was made.

The patient was then moved to the truck to begin treatment. At this time the drama and yelling calm down, but the patient still complains of severe difficulty breathing (lung sounds are still clear all fields), pt has a small abrasion to the lateral side of the lower lt rib cage, as well as across the abdomen, and brusing has already started below the rib cage. No crepitus or unequal movement of rib cage. Patient is still guarding. Pulse ox on NRB =100%, pulse 70-80 bpm, etco2= around 38, b/p = 150's over 70's.

Can you consider mechanism?

What category is this patient?

Is Starflight appropriate?

Send me your thoughts and I will let you know of the outcome.

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#5599 - 06/20/05 10:41 PM

Re: Call discussion [Re: Tammy Mezayek]

Aaron Langford
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Registered: 05/05/03
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An interesting call, Tammy. I personally would call him a CAT2, 20+ mph auto/ped is CAT2, so 30+ seedoo should be also, in my mind. If the patient is already experiencing abd bruising, it's a good bet that he might have a surgical abdomen and since you are a good hr from Brack at M22, STARFlight is a good call. Could have a punctured lung and be developing a pneumothorax even w/ clear breath sounds. Just my thoughts.

Aaron

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#5600 - 06/21/05 01:10 PM

Re: Call discussion [Re: Aaron Langford]

Corey Ricketson
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Key word should be. There are many things I do not like about our category's. They do not include a lot of mechanisms we run on, like sea doo's. I would have to call him a cat 3 but agree he should be seen at a trauma center. Unfortunately, we don't have a cat 2 by medic discretion designation. Is STARFlight appropriate? Since you are suspecting internal injuries and you are way out on the north side of the lake I would think so. His vitals don't put him into a cat 1 classification but my guess is this patient could jump from a cat 3 to a cat 1 rather quickly. Report would paint a picture of a cat 3 mechanism with injury's and high level of suspicion to indicate a trauma team evaluation. Most likely some fentanyl will do this patient a lot of good and allow for a more thorough assessment, however, we don't carry fentanyl, thus a continuation of our problems.

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#5601 - 06/21/05 02:47 PM

Re: Call discussion [Re: Corey Ricketson]

Adam Johnson
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Quote:

Key word should be. There are many things I do not like about our category's. They do not include a lot of mechanisms we run on, like sea doo's. I would have to call him a cat 3 but agree he should be seen at a trauma center.

Kinda interesting point from the Comm side... MPD actually has a criteria (based on potential mechanism) for Personal Watercraft Accident, which indicated a higher priority response. In our system, it is a priority 2 call... Similar to an auto/ped, motorcycle collision, etc. Just thought I would throw that in.

Edited by Adam Johnson (06/21/05 03:24 PM)

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#5602 - 06/21/05 04:03 PM

Re: Call discussion [Re: Adam Johnson]

Tammy Mezayek
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Thanks for the responses. For me this was tricky. I did not want to call starflight only to find out that he wasn't tolerating a fractured rib well, but once I found out that he was hit at 30+ mph, I decided that was pertinent info, and called him a Cat 2. Once SF had arrived, I was still a little apprehensive because his v/s were very stable, but thought i'd just fade the heat if I found out he was only a cat 3. After the call Chrissy called me to let me know that he was developing a small pneumo, but that he also had a splenic fracture. Turns out my gut feeling, although initally was not justified, was still right. Trust your instincts.

_________________________
I am focusing all my energies on this one thing: forgetting the past and looking forward to what lies ahead.
Philippians 3:13

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