CBT 445 Head & Spine Thoracic Scenario 1
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1 CBT 445 Head & Spine Thoracic Scenario 1 Evaluator s notes: Patient 36 year old male fall patient, Impaled branch, quick transport to ER. Dispatch/Description of the problem: You are dispatched to 36 year old male fall from a ladder. What you see upon arrival: You find the 36 y.o. patient conscious and lying at the bottom of a 20 foot ladder on his right side. He has been impaled by a branch that he just cut off a tree he was trimming. Patient states branch knocked him off the ladder. Blood Pressure 100/p 110/74 98/70 Pulse Respirations 36 labored 36 labored 40+ labored Skin cool/clammy/pale warm/dry/pink warm/dry/pink Lung Sounds Clear/decreased on right Clear/decreased on right Level of Consciousness A&O x3 A&O x3 A&O x3 Not Normal O2 Saturation 96% 92% 92% Blood Glucose Sudden fall off ladder fall from ladder some 10 minutes ago S signs and symptoms Alert but C/C= chest pain; SOB NKDA none Lunch 3 hours ago E events leading up to the illness Fall from ladder about 6 to 8 feet Results from a patient exam: Rapid trauma exam finds misc. soft tissue injuries and branch impalement into right chest not all the way through. Patient is coughing up bright red blood. Call for man power and ALS; Stabilizes impalement, prepare for packaging. Treatment. Packed gauze into wound and stabilized the branch once cut, Back board c-collar, O 2, and monitor vitals. If then statements. This patent develops more and more sub Q air, but there are no signs of tension pneumothorax per medic Transport yes or no; mode Emergency mode ALS
2 CBT 445 Head & Spine Thoracic Scenario 2 Evaluator s notes: Patient 20 year old male headache, head bleed, quick transport to ER. Dispatch/Description of the problem: You are dispatched to 20 year old male headache. What you see upon arrival: You find the 20 y.o. male patient conscious holding his head and babbling incoherently as he walks around the room. Attempts at interview and exam are futile, he will not follow commands. Patient responds to his name and does not attempt to answer questions on place or time. You check BGL and it was a rodeo to do it. Friends state he was playing tackle football w/out pads, and hit his head on the ground when tackled. He was out X 1 minute then fine, and continued to play but became a bit confused on the way home. By arrival at his house, he is REALLY confused. Blood Pressure 140/p 146/84 166/84 Pulse Respirations Skin warm/dry/pink warm/dry/pink warm/dry/pink Lung Sounds Clear/= Clear/= Clear/= Level of Consciousness A&O x2 A&O x2 A&O x2 Not Normal O2 Saturation 96% 92% 92% Blood Glucose 116 Sudden headache head injury unk 2 hours ago S signs and symptoms Alert but confusedc/c= headache NKA none Hearty breakfast 4 hours ago E events leading up to the illness Lost consciousness playing tackle football without pads 2 hours ago. Results from a patient exam: Rapid trauma exam finds misc. soft tissue injuries big one on frontal lob area. Call for man power and ALS so you cam back board the patient; Patient continues to be totally confused and is becoming combative, prepare for packaging. Possible head bleed. Treatment., Back board c-collar when help arrived, O 2 attempts are also futile, monitor vitals. If then statements. This patent becomes more combative restraints are needed Medics arrive hear the story and opt to paralyze and intubate patient. Medics let mom know what is going on. Transport yes or no; mode Emergency mode ALS to HMC.
3 CBT 445 Head & Spine Thoracic Scenario 3 Evaluator s notes: Patient 30 year old female MVA; c- spine precautions, Possible KED use and rapid trauma survey prior to extrication transport to ER Had C2 fracture. Dispatch/Description of the problem: You are dispatched to 30 year old female MVA. What you see upon arrival: You find the 30 y.o. female patient conscious sitting in her car sit belt on. Heavy front end damage to front of car all front air bags deployed. Witness s state there was no attempt to brake before impact when she rear ended the bus. Blood Pressure 124/p 126/78 122/84 Pulse Respirations Skin warm/dry/pink warm/dry/pink warm/dry/pink Lung Sounds Clear/= Clear/= Clear/= Level of Consciousness A&O x3 A&O x3 A&O x3 Normal Blood Glucose 116 MVA neck pain unk 8 minutes ago S signs and symptoms Alert C/C= neck pain seafood Birth control pills 2 hours ago E events leading up to the illness: She sheepishly admits that she was texting, and did not realize the bus has stopped in front of her. Not Results from a patient exam: Rapid trauma exam finds misc. soft tissue injuries face and arms areas from the air bags and seat belt. Full exam in back of aid unit no other injuries found. Call for a medic from on-scene yes or no; why? NO Treatment: Back board c-collar, O 2, monitor vitals. If then statements. The ER calls back 2 hours later. They say great job with the c-spine, she broke C-2 and might have died or been paralyzed at the scene otherwise! Transport yes or no; mode BLS.
4 CBT 445 Head & Spine Thoracic Scenario 4 Evaluator s notes: Patient 17 year old male football injury; c- spine precautions, rapid trauma survey prior to back board, transport to ER brain trauma. Dispatch/Description of the problem: You are dispatched to 17 year old male altered LOC on football field. What you see upon arrival: You find the 17 y.o. male patient conscious sitting on the bench helmet off. Pt tells his coach part way into the 3 rd quarter, When is the game going to start. Witnesses state he hit helmet to helmet with another player, Blood Pressure 100/p 126/78 122/184 Pulse Respirations Skin warm/moist/pink warm/moist/pink warm/dry/pink Lung Sounds Clear /= Clear/= Clear /= Level of Consciousness A&O x02 A&O x2 A&O x2 Normal Blood Glucose 92 S severity Helmet to helmet hit 30 minutes ago S signs and symptoms No C/C= Head injury P previous medical history E events leading up to the illness Helmet to helmet hit causing brief unconsciousness for about 2 minutes and has been confusion since. Results from a patient exam: Rapid trauma exam finds no obvious injuries. Full exam patient has no recollection of playing already. His neuro exam is symmetrical. But LOC is altered. Call for Medics. Treatment. BGL check, Back board c-collar, O 2, monitor vitals. If then statements. The patient continues to be confused. Transport yes or no; mode: ALS.
5 CBT 445 Head & Spine Thoracic Scenario 5 Evaluator s notes: Patient 20 year old female diving accident; c- spine precautions, rapid trauma survey prior to back board, transport to ER brain trauma. Dispatch/Description of the problem: You are dispatched to 20 year old female unconscious at pool. What you see upon arrival: You find the 20 y.o. female patient unconscious lying on the side of the pool. Life guard tells you she struck her head on the diving board and was out before she hit the water. They pulled her out and on to the deck before you arrived. Blood Pressure 140/p 136/84 180/100 Pulse Respirations Skin warm/wet warm/wet warm/dry/ Pupils not equal & reactive not equal & reactive not equal & reactive Lung Sounds Rhonchi /= Rhonchi /= Rhonchi /= Level of Consciousness A&O x0 A&O x0 A&O x0 coma Blood Glucose 92 S severity head vs diving board 7 minutes ago S signs and symptoms No C/C= Head injury P previous medical history E events leading up to the illness Struck head on diving board Results from a patient exam: Rapid trauma exam finds nasty gash on forehead and bloody nose obvious injuries. PT vomits. Full exam patient pupils react to light but right is 4mm and left at 8mm. Pt seizures for 2 minutes. Treatment. Back board c-collar, O 2,suction with c-spine precautions, monitor vitals. If then statements. The medicarrive and treat for head injury. She is intubated and rapidly transported to HMC. Transport yes or no; mode: Emergency ALS.
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