BSI scene safety. Mechanism of injury. I have a gunshot wound.
I have one patient. I am going to request additional ALS and transport and I'm
going to have one of my partners hold c-spine midline stabilization while my
other partner cuts off the clothing, exposes my patient.
I am going to assess the level of responsiveness of my patient. Sir, sir. No response. I'm going to
give a trap squeeze. Patient grunts. Okay my patient is responsive to painful
stimuli. Is there any apparent life threats that I see?
There is a gunshot wound to left pec. Okay so I'm going to apply pressure.
Have my partner give me an occlusive dressing and apply the
occlusive dressing, taping three sides down. Does it hold?
It does hold. Okay what I want to do is assess my patient's airway with a modified jaw thrust.
Do I seen anything? You do not see anything. Okay we want to properly size an OPA from the
corner of the earlobe to the corner of the mouth.
Inserting it, turn 180° so it sits on the lips. Did my patient accept? Your patient does
accept. Okay I want to get a respiratory rate and listen to lung sounds of my
patient. Are they clear? Lungs are clear. What's the respiratory
rate? Respiratory rate is 10 and shallow. Okay we're going to get a BVM and
ventilate our patient 15 liters of high flow oxygen, one breath every five to six
seconds at a rate of 10 to 12 per minute.
Circulation. Any bleeding going on? No other bleeding is found.
Okay what about pulses? Pulse is present it is at 110. Pulse 110. Okay skin color,
temperature, condition? Warm and diaphoretic. Okay so my patient is exhibiting signs of
shock so what I'm going to do is have a blanket on standby. We
are giving our patient oxygen therapy to treat for that. This is a high priority
patient so we're going to load and go code three the hospital,
but first c-collar. With the help of my partner and the head man's count what
we're going to do is we're going to roll the patient. In three, two, one roll him. I'm
going to clear the back looking for any DCAPBTLS, any
step-offs, exit wounds, anything that I see? You find one exit wound. Okay
so applying pressure, getting another occlusive dressing from a partner,
applying it, taping three sides. Does it hold? It holds.
Okay on three, two, one head man's count we're going to roll him back then secure
them to the backboard. Is there anybody around that I can get a
sample history from? No one is around. Okay
can I get a complete set blood pressure respiratory rate, heart rate? Blood
pressure is 90 over 60, heart rate is 110 and respirations are 10
and shallow. Okay I want to do a complete assessment of my patient
starting at the head, DCAPBTLS deformities, contusions, abrasions,
punctures/penetration, burns, lacerations and swelling. Do I see anything? You do not
see anything. What about his eyes, nose, mouth, or ears? Any cerebral spinal fluid or
any fluids leaking out, blood or anything? You do not. Okay we're going down to the
neck. Any jugular vein distension, JVD, or a tracheal deviation? You do not. Okay
On the chest is my dressing still holding? Still holding.
Okay I'm still going to listen to breath sounds. Still clear? All clear.
Okay I'm just gonna palpate make sure I don't see any flail segments, or crepitus,
or anything. Do see anything? You do not see anything. Okay what about the abdomen? I'm
going to start in one quadrant and work my way to the other ones. Abdomen is clear.
Abdomen is clear, soft non-tender. Okay come to the pelvis here what I want
to do is I'm going to come in and down looking for any crepitus, deformities,
anything? You did not find anything. Okay while I'm here I'm gonna just ensure that there's nothing
abnormal, any fluid or anything coming from the
private area. I'm going to start on the leg looking for any deformities, any bleeding,
DCAPBTLS, crepitus anything? You do not fine anything. Same on this leg here?
All clear. Okay pulses, pedal pulses present?
Present. Okay I'm going to come up, one arm, same thing any crepitus,
deformities, anything? You do not find anything. On this side deformities, crepitus or anything?
You do not find anything. Pulses. Pulses are present. Okay so I'm treating my
secondary intervention there with that exit wound. This is a high priority patient.
I'm going to be reevaluated and reassessing my patient every 5 minutes on our way to the
hospital. We are transporting code 3.