Power Tools
It's easy for me to quip about how we in the emergency response field are defeating natural selection, but the things aren't so jovial, when I park in someone's front yard and run past a girl that's crying because the paramedics are working on GramPaw, who just had a heart attack. As I came into the living room the other day, said grandfather wasn't looking good, as the EMT, who had just finished hooking up a five-lead monitor, began compressions. The paramedic calmly but efficiently began getting out his heart drugs. This looked like a dog and pony show for the family.
As I moved furniture to make access to get the guy out, I watched the paramedic get out a pretty nifty little red power drill. I'd never seen one, but my buddy Ambo Driver had told me about them before, so I recognized it for what it was: an intraosseous infusion power driver. He drove a trocar right into the patient's tibia. As he did so, I could hear the light little power driver motor bogging down as the threaded insert drew down tight to the patient's shin, enough to make the skin pucker just a bit. The paramedic then screwed in a line, and began squirting drugs into that line. Quite a lot of drugs. It hadn't struck me before how big a guy Gramps had been. Wow. More drugs?
They boarded him. C-collared him (why? WHY? He had a heart attack and fell to the floor. No evidence of neck trauma.), and then began to try to get him out of the house. two of us had the head, and the paramedic had his feet. Like many houses, this one was not designed to make it easy to get a gurney in or out of, so we brought he board out to the gurney. At the turn in the hallway, I just took the head, in time to realize that GramPaw had been a big ol' boy. We got him down the stairs, into the box, and I stood by with a deputy, trying not to look at the growing crowd of family members, crying and hugging each other, talking about GramPaw.
This man was loved. But I really didn't feel like GramPaw had a chance.
Later that night, the paramedic dropped by the P.D. GramPaw was stable when they left the hospital, and at last check had a room at the ICU.
Labels: day at the office, family, Field Expedients, health stuff
posted by Matt G @ 3:00 PM
7 Comments:
For better or for worse, they collared him because he fell. Ambulance Driver might not approve, but they were trained on stories of people who suffered trauma in any form, were walking and talking when EMS came on scene, then were found to have broken cervical spines when they reached the hospital.
That's probably protocol in Texas (it is in most states) and way above their pay grade. They either do it or face serious consequences, possibly the loss of their licenses.
The usual reason for a C-collar in a code is to (counter intuitive as it sounds) to help keep the advanced airway (i.e., "breathing tube") in place. The airways secure down below (or at depending on the type) where the airway parts company with the esophagus. They are also secured at the mouth to help keep them from being pulled out by careless or overzealous responders.
The problem is that the internal distance between the mouth and the glottis varies based on the head position. Minimizing the movement of the head and neck reduces the changes in distance for the airway, making it theoretically less likely to be dislodged.
Probably collared him to help keep his endotracheal tube secured. The less his head flops around like a bobblehead doll, the less likely you are to dislodge that tube you worked so hard to get.
I do the same thing.
He wasn't intubated, yet. The guy with that task wasn't able to find the trachea. (The pro with the power drill did it in the box, later.)
You learn something new every day. I hadn't heard of using a C-collar to keep an ET tube in place. But we're EMT-B student and the main thing they tell us about ET tubes is "here's how it goes in, practice it, but remember that you will not do this in the field."
In my EMT class, you'd be expected to say you would "do c-spine" because he fell. Same answer if the arrest wasn't witnessed and he *could* have fallen or *probably* fell.
Heck, maybe they just collared him because they figured he might get hurt while doing the equivalent of being tossed though a maze by a herd of gorillas.
I've threatened to put a roll-up door into the living room of a previous badly-designed house because it was so dang hard to get furniture in with the 90 degree corner in the entryway and another to get to the main hallway that I didn't even want to think about EMS having to figure a way to get me out of there if anything happened.
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