Medical. : Medicine.

I have one:
Male, 20's finds his girlfriend screwing another guy. Said male attempts to beat second dude up and tries to take his knife. Second dude stabs pt. in neck. Pt. runs and hops back fence. Dude runs after pt. and strikes pt. with a baseball bat prior to hopping said fence. I find pt. awake, pissed off and crying with a stab wound neck (zone 2 injury Lt. side) and a large occipital lac. / bleeding.

Questions: What to do (w/o laughing}:-)), what are you looking for and what is a zone 2 injury?

F.M.
 
Two main concerns with a neck injury: occult bleeding and soft tissue swelling that could occlude the airway. Is the blade still in the stab wound?? If so, do NOT remove it!! Pad it, stabilize it however you can for transpo. It might be the only thing standing between you and an arterial pumper. Use backboard for transpo, securing the head/shoulders from as much movement as you can. Monitor LOC, VS for s/s of shock, and continue to assess airway, providing O2 support (canula through intubation if needed). Of couse get your IV access via large bore cannula, 2 sites if you can.

I will leave it to the EMT guys to fill me in on the zone designation
 
FM - Remind me to make sure I have my car crash in your AO. Good going on keeping internal issues in mind while you're focusing on the obvious broken and bleeding. I was heading down the intra-abdominal bleeder route with this one
 
quoted for reference: (2): A.B.C.'s, typical P.H.T.L.S. primary / secondary survey, spinal prec, transport--> Civilian world: Level-2 trauma, Army world: Urgent status, Medevac, I.V.'s kvo, monitor and look for blast injuries especially hollow organ injuries (blast lung). Pain mangement as long as no head injury / splint if time permits. What is the G.C.S. / neuro. status. I am worried about internal / blast issues and the poss. of shock (even know the v/s. don't show it YET).

(1):Triage of course, # of patients, injuries, resources needed, scene secure / perimeter secure?

F.M.

also: MACE test if patient is AOx3 or better. use best judgement. most of my guys are never AOx3, because the days run together, and let's face it, some of them are just retarded on a good day. you probably won't make it throught the whole test before v/s start showing problems, but you can have an idea how well they got their bell rung.
 
fuck me. you go to bed early just 1 night, and miss all the damn fun. silly Helo. :)

don't know about zones - but if the wound isn't spurting, bulky dressing, secure it well. lightly but securely bandage occip. wound, and monitor for changes in mentation, pupillary mismatching, things like that. what's his GCS? AOx3? PEARRL? Keep him talking to A) keep him from going to sleep and B) to assess his airway - if it gets difficult, I may have to intervene.give him a once over to make sure I didn't miss anything, and then get him to the ER. try to get my partner to stop laughing so I can keep a straight face. (yeah right!!) No pains meds - sorry Chuck, should've fucked her at YOUR house.
 
Military Acute Concussion Evaluation. short little test they give you before and after an event to register your brain function... the one before you deploy gives you a control, the one you give the patient and any subsequent exams related to the significant event give you an indication of what, if any, changes have occured. it's a nice tool to help you know if your guy just got the piss knocked out of him, or just a little shaken up, r somewhere in between. once you've done a couple, you can give one in 5 minutes or less.
 
Here is a new one:

16 y/o male, overdose on amytrpitiline (spelling wrong) (what is this / I know already )?
B/P: 98/60. HR: 140, RR: 22, ECG: Sinus tach with widened QRS'S, TEMP: 100.2, Mental: combative with periods of calmness then seizures..................Hint: Really bad! No other meds., drugs or ETOH. No recent illness, trauma or h/x of overdoses.

What is the diff. diagonosis?
What is anticolinergic syndrome?
What is the neumonic for the above syndrome?
What can this med and meds like this do to you?

F.M.
 
◦Amitriptyline

essentially, anticholinergic syndrome is where there is an interference with the autonomic nervous system receptors - i.e. sweat glands, salivary glands, GI/GU tracts and the Heart. all of these function automatically, and there are a host of drugs that can chemically alter how they function, either directly, like promethazine, cyclobenzaprine, and benedryl, and others, like the one above, do it through control of the body's natural hormones. in this case, the drugs shut them off, hence why the patient isn't sweating. also - the seizures come from a build-up of acetylcholine at the end of the nerve... essentially - the signal is getting transmitted, but it's not being processed, only stored - and the acetylcholine continues to build.

and it's red as a beet, dry as a bone, blind as a bat, mad as a hatter, and hot as a hare. it's similar to some chemical agents. more to follow, I just wanted to beat everyone else to the punch :p
 
what I would do -

again, similar to nerve agent exposure. Diazepam 5mg for seizures, Narcan 2mg, I don't have Thiamine, but you probably do, watch his vital signs closely. IV access is a must, check his blood sugar if possible. he needs ALS, which I may not be prepared to give here, definitely point that out in a call to higher, whether that's dispatch, or Dustoff.

Diff diag is antidepressant toxicity. meds like this can kill you.
 
Ditto the good job helo!! We've had a rash of OD's recently and actually I expect to see more with the econ as depressed as its been. Locally we depend on lots of smaller manufacturing companys for local jobs and things are getting dicey. We had one a couple of weekends ago, girl shot up H for the first time and resp arrested
 

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