WordPress.com



Wilderness – Femur FractureScenario InformationTitle:Wilderness – Femur Fracture & Hypothermia Date Created:13 April 2016Target Audience: FORMCHECKBOX PCP I FORMCHECKBOX PCP II FORMCHECKBOX PCP FORMCHECKBOX ACP FORMCHECKBOX CCPScenario Author:Will JohnstonAuthor Contact:C_johnston37@fanshaweonline.caScenario OverviewPatient was participating in a week long camping retreat and is very new to camping. There is a thunderstorm and the retreat has been going on for ~3 days. While hiking to the washroom at night the patient slipped down a ravine and fell approximately 8 feet. The patient has a fractured R femur and L ankle. The patient is laying in ~6 inches of water. Due to long transport time and time to scene (15 minutes through forest) on Paramedic arrival, the patient has been immobile in the ravine for 50 minutes. The patient should be extricated quickly with a traction splint applied. An evacuation plan should be arranged (utilizing Air ambulance as per Trauma Triage Guidelines/Air Ambulance Standard) and the patient should be treated for hypothermia.Scenario Objectives, Summary, NOCPS, and ExpectationsLearning Objectives:Apply the Air Ambulance Utilization Guidelines and Field Trauma Triage GuidelinesAdapt to a dynamic patient presentation with multiple injuries and hypothermiaEstablish a clear plan of care including medical evacuationAssociated NOCPs 5.7.a – immobilize suspected fractures involving the appendicular skeleton5.7.b – immobilize suspected fractures involving suspected fractures involving the axial skeleton6.1.g – provide care to patient experiencing signs and symptoms involving musculoskeletal system6.1.n – provide care to a patient experiencing signs and symptoms due to exposure to adverse environments7.4.a – prepare a patient for aeromedical transportParamedic GRS1 Expectations:Situational Awareness: recognize the patient’s need to be extricated from the waterHistory Gathering: gather a good history including MSK history and incident history (including length of time since injury)Patient Assessment: MSK assessment including CSM, rapid body trauma surveyDecision Making: applying traction splint, remove patient from waterResource Utilization: evacuation chain activated early Communication: effective communication with patientProcedural Skill: proper spinal boarding, traction splint applicationTavares W, Boet S, Theriault R, Mallette T, Eva KW. Global rating scale for the assessment of paramedic clinical competence. Prehospital emergency care. 2012 Dec 5;17(1):57-67.Scenario PreparationPatient RequirementsMoulagePatient InstructionsBruising to the patient’s R leg (red, brown, blue make-up)Bruising to patient’s L ankle (red, brown, blue make-up)Shock make-up (pale and blue)Patient should externally rotate their right legPatient clothing should be wet (use discretion as this may create patient hazards) Instead could be told patient is wetPatient is confused and semi responsivePatient is responding slowly to verbal cues Patient is shivering throughout scenario. As this is taxing. The SP can periodically shiver for 20-30 second intervalsPatient should have an altered LOA, A&O to person and time, but not place or eventAdditional Equipment and PropsPropsEquipment Head Lamp Camping Attire (as per individual running the scenario)Spinal BoardStretcherBLS Bag, O2 Bag, Monitor if applicableTraction SplintScene Set-UpThe patient should be placed at the bottom of a ravine or ridge (if possible)The patient should be laying in a position that is comfortable for them with head at bottom of the ridge or ravine (Consider the patient has been laying on the ground for an extended time, would move to a position of comfortIdeally this scenario is completed in the dark, lights out is acceptableBystander Bystanders did not notice the patient fall initially, went to search for him after they noticed he was not with the group Bystander attempted to move the patient out of the ravine. ++ Pain prevented extricationBystander has basic information about the patient, is a friend of hisBystander is able to provide basic First Aid treatments as directedBystander offers up that the patient has likely been down “for a long time, how long does it take you guys to get here” Dispatch Information You are called code 4 for a fall hiker who fell in a forest area approximately 35 minutes from your location. The weather has been wet, rainy, and cold (4 degrees) for the past week. After arriving at the scene it takes you approximately 15 minutes to navigate to the patient through the forest where you meet other bystanders at the top of a ridge/ravine approximately 8 feet down you see a 25ish male. The closest local hospital is 15 minutes away. The closest Trauma hospital is 50 minutes away by land.Patient Information Patient Name: Cpl. Mark AshtonAge: 23Weight: 75Gender: MChief Complaint: Multiple Trauma and HypothermiaHistory of Present: Patient was walking in the dark attempting to navigate, patient fell down ravine ~8 feet landing on R and L legs. Patient has been laying for ~50 minutes in water and cold.SAMPLE History: AllergiesAmoxicillinMedicationsNonePast HistoryPreviously HealthyOral Intake~3 shots of whiskey earlier in the eveningOPRST (If Applicable) OnsetR Leg: 20 Minutes L Leg: 20 MinutesProvocationR Leg: Any Movement L Leg: Any MovementPalliationR Leg: None L Leg: NoneQualityR Leg: Throbbing Ache L Leg: Sharp Radiation R Leg: Down into Ankle L Leg: Up into kneeSeverity R Leg: 6/10 10 with move L Leg: 8/10 10 with movementTimeR leg: Initial 10/10, L Leg: initial 10/10Additional InformationPatient felt a snap in his L ankle and heard a loud Crack and snap in his Right thigh Patient is unable to weight bare at allPhysical FindingsPrimary Survey:AirwayNo Trauma, patient able to maintainBreathingRapid and labouredCirculationRapid central pulses Auscultation Clear and equal, no adventitious sounds Distal PulsesL Leg: Strong distal pulse, R Leg: no distal pulse, cool to touch ShockPatient is cool to the touch and paleSecondary Survey :Head UnremarkableNeckNo trauma, airway patent, no JVD, trachea midline, no c-spine tendernessChestEqual chest rise, no pain on inspirationBackUnremarkable PelvisPelvis stableLegsL femur intact, R femur: ++ deformity, bruising, instability, crepitusExtremitiesNo distal pulse on patients R lower extremityVital Signs, Expected Actions, and ModifiersPatient State 1:State: Initial FindingsTRIGGER: Start of the Scenario Vital Signs Expected ActionsHR 56 WR Rapid trauma surveyOxygenIV Access with fluids (as per protocol)Patient should be attached to the spinal boardPatient should be extricated from the water as soon as possible Active rewarming should be startedTraction Splint AppliedProper extremity splinting of ankleSPO296BP90/60CO2 55RR12 ShallowTemp35.2SkinCoolGCS14Pupils++BGL4.2ECGSinus Brad12 LeadSinus BradycardiaModifiers If the patient is not removed from the water by 15 mins advance to STATE 2If the patient is removed without injuries being splinted in some way, the patient will become aggressive and scream in painTrigger Not Removed/No Warming (STATE 2) 25 Minutes: END OF SCENARIOPatient State 2: State: Severe HypothermiaTRIGGER: Patient not removed from water/no warming Vital Signs Expected ActionsHR30 weakOxygen 100% Ventilations Call for rapid evacuation Active warmingRapid Extrication PATIENT IS NO LONGER SHIVERINGSPO2CNOBP90/60CO270RR8 shallowTempLOWSkinColdGCS2, 3, 5Pupils++BGL3.0ECGBrad with Osborn Waves12 LeadOsborne Waves Modifiers If patient is not extricated will go VSA at 24:00If the patient is extricated without being spinal immobilized/having some sort of splinting done, patient will scream in pain and become aggressive for a short periord of timeTrigger 25:00 END OF SCENARIO ................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download