Medical and Trauma Scenarios **Graphic Pics**

[apssbc]

Ive done this before but without the pictures. I want to try and continue to post these scenarios for all of us to review and "treat." I think this could be of huge benefit for those who need a refresher or who have never handled these before. Do your best to tell how you would handle/treat these patients. You can approach from a SHTF direction (End of Days, you're all the medical care they got) or even from a every day perspective (as if it happened today as you were driving home). Both perspectives could be beneficial to us.

Your first scenario is a 12 year old boy running with a stick when he tripped and fell. You are back in the woods when you and another person find him. He is alert and breathing normally. With your medical equipment how would you treat him?
http://i647.photobucket.com/albums/uu198/emmettfire45/69239_10151450507698624_1994371873_n_zpsb78aaffd.j pg (http://s647.photobucket.com/user/emmettfire45/media/69239_10151450507698624_1994371873_n_zpsb78aaffd.j pg.html)

[mitunnelrat]

Thanks. I missed the Wilderness First Aid course last month in favor of my grandma's 80th birthday!

Luckily, in normal life there's only one a couple patches of woods I tend to stomp around in. One more than the other, but both have cell coverage and clearings a helicopter could potentially use if the road is too far off. First thing with the boy is to reassure them I can help as I assess him, and get my friend to call 911.

Now I've got to think a little harder. Feel free to tear me a new asshole if I do something wrong, I'm a long time out on this. Anyway, the stick in the pic above looks like bamboo to me. What I believe I'd do is leave it in his neck, packing gauze pads and rolls around it on both sides to control bleeding and stabilize the stick. That done I'd want to stabilize his head, so he can't move it and cause more tearing or damage. Maybe improvise a c-collar with duct tape and clothing?

Continue monitoring for shock, follow the instructions from the emergency dispatch, and hold him in place for SAR or move him as needed. If SAR is coming in, I'd send my friend to lead them in. If we have to move? Terrain and distance might impact the available options. Walking if he's up to it, two man carry, a travois, or litter. Either of those last could be fashioned from a poncho, cord and saplings.

Otherwise, idk. This is still a bit outside my lane.

[mitunnelrat]

Nobody else has anything to chime in with?

[ak474u]

I would first tell him... "This is why we don't run with sticks!" I would say immobilizing the neck would be important and a critical element of the response, there's all kinds of important stuff in the neck, and ANY movement might be the end of the line for that wound. I'd probably do everything MTR said, and possibly try to saw that stick down to a more manageable size because it would be really easy to bump it during any necessary transport to medical care. Obviously, putting pressure on the stick to cut it may be an issue. A loose gauze wrap around the neck would also help to eliminate some movement by stiffening the neck, and might help with retention of the stick.

[Twitchy]

oh the joys of trauma...

BLS response, C-SPINE PRECAUTIONS! I want a full set of vitals, keeping an eye on the B/P and pulse for signs of shock. Have someone attempt to saw that stick down to a manageable size if it doesn't aggravate the wound more, I was thinking a Saw-zaw would probably work best... Stabilize the stick with gauze / rolled up pads. PT gets 6 LPM O2 via nasal Cannula, upgrade to a non re-breather mask at 15 LPM if shock sets in... If I am in the woods with a delayed transport time, reduce it to 10 LPM to preserve the length of time you can administer O2. Transport the patient to a trauma center for definitive care.

Primary concern here is shock, and keeping that thing immobilized.

Omitted some things such as assessments as most people won't know how to assess anyways, but in this case, I would have used DCAP-BTLS as well as SAMPLE, OPQRST, and AVPU to make sure this wasn't caused by something medical related (I.E. syncope episode caused him to fall. This scenario is strictly trauma though hence why i omitted it.)

[mitunnelrat]

I see I forgot to mention cutting the stick down myself, but that's why I noted it looked like bamboo to me. Wouldn't be the worst thing to cut then.

Twitchy, you'd have to have somebody with a damn good grip and no fear of that blade to run a sawz-all for that I'd think. It may cut it quick, depending on how hard that wood is, but would you want to subject the patient to that forceful a vibration?

If there's tools like that available I'd be looking for a set of long handled pruners/ loppers I think.

[ak474u]

I avoided saying just rip it out, and rub some dirt on it.

[NWPilgrim]

If there is hope of getting him evacced for professional treatment the all of the above advice. But if you are way out there and not possible to transfer then what? How long of a delay for transport would be worth just to immobilize and treat for shock? How long would you wait before trying to remove and clean and suture or staple? I imagine odds might be fairly thin at that point. But in a day or so is mot infection becoming a serious risk as well?

[apssbc]

Very good responses by all. Simple steps if you have the possibility of rescue:
-Check Airway and pulse.
-Stabilize the stick and dress around the wounds.
-Cut the stick down.
-Immobilize if possible
-Have him evaced or walk out if need be.

Those are the very basic steps. The rest have been covered in detail in the above posts. Obviously treat the patient to the skill level you have.

When it comes to ditch medicine with no possibility of rescue things change. You will need to remove and secure the stick. Depending on how far the stick is lodged in his neck will depend how it's removed. If its just below the skin it might be worth cutting the skin and pulling it out sideways. If its buried deep inside the neck and might involve the jugulars, carotids, or even tendons and muscles you will have to be more careful. A smooth stick may be able to be slid out, a jagged stick could really be a problem as you can't cut it out or pull it out easily.

The basics of it will be to sterilize yourself and the patient if possible. Wear gloves if available. Remove the stick whatever way is decided. Prepare for major bleeding as the stick may be plugging major blood vessels that may bleed as soon as the stick moves. Control any major bleeding. Suture or cauterize bleeding vessels. Irrigate the shit out of the wound. Suture the deep muscles and allow it to heal from the inside out. After some time allowing the wound to breathe and heal, suture the outside. Then you need to cover the opening and try to keep sterile, give antibiotics if available. Monitor closely.

[Twitchy]

Very good responses by all. Simple steps if you have the possibility of rescue:
-Check Airway and pulse.
-Stabilize the stick and dress around the wounds.
-Cut the stick down.
-Immobilize if possible
-Have him evaced or walk out if need be.

Those are the very basic steps. The rest have been covered in detail in the above posts. Obviously treat the patient to the skill level you have.

When it comes to ditch medicine with no possibility of rescue things change. You will need to remove and secure the stick. Depending on how far the stick is lodged in his neck will depend how it's removed. If its just below the skin it might be worth cutting the skin and pulling it out sideways. If its buried deep inside the neck and might involve the jugulars, carotids, or even tendons and muscles you will have to be more careful. A smooth stick may be able to be slid out, a jagged stick could really be a problem as you can't cut it out or pull it out easily.

The basics of it will be to sterilize yourself and the patient if possible. Wear gloves if available. Remove the stick whatever way is decided. Prepare for major bleeding as the stick may be plugging major blood vessels that may bleed as soon as the stick moves. Control any major bleeding. Suture or cauterize bleeding vessels. Irrigate the shit out of the wound. Suture the deep muscles and allow it to heal from the inside out. After some time allowing the wound to breathe and heal, suture the outside. Then you need to cover the opening and try to keep sterile, give antibiotics if available. Monitor closely.

Eh, if the jugular or carotid are punctured, removing that stick will be the end of little johnny... Tough call in that case, call a priest, say goodbye, and give it a shot at removing it via cutting it into a manageable position, with loppers or whatever (good on that idea MTR) and gently try to push it out the way it entered... pulling can cause more damage...

[realist]

Sucky position to be in. Once removed put on an occlusive dressing to prevent any air from getting in. He doesn't look too bad but that can change pretty fast.

[Twitchy]

Sucky position to be in. Once removed put on an occlusive dressing to prevent any air from getting in. He doesn't look too bad but that can change pretty fast.

+1 on the occlusive dressing... forgot that part... Would much rather a physician be the one to remove it, and patch it up though...

[Sniper-T]

K, I'll be the one who plays the worst case scenario... I typically play in the deep woods, days away fom any help, at the best of times!

I would cut the stick off, to a manageble length, irregardless of the pain, because it would facilitate removal. I would pack it tight, and as long as his breathing was not hindered, I would leave it in place, and work him out.

IF however, his breathing became comprimised, then issues would arise!. I would deaden the pain as I could...and then starting on the outside, cut my way in. from the pic, It is impossible to see if the jugular is inside the penetration or out. so I would work my way in.

given my usual play locations, if this becomes a situation, I would cut, slice, and hold any position I had to until help arrived!

[apssbc]

That's what I'm thinking sniper. It sucks but that's Hoya it would have to work. Especially post SHTF.