Thursday, May 20

Done (I Hope)

State written final was tonight. Overall I think I did well but will know for sure in four to six weeks (YECH!).

One question I was confused about went something like this:

Child patient riding a bike and hit by a car.  Initial assessment shows no life threatening injuries and rapid trauma assessment shows deformed right arm and deformed right leg.

Two answer choices that were even considerable were:

     PMS both extremities, take time to splint each extremity separately, board, load.

     Fix both extremities to body, move to long board, load and go.

I picked the second choice and everyone else I spoke with, including the course instructor, went with the first choice.  My rationale was this:

1) Our state pediatric trauma protocol says that kid + bike + car = major trauma.  BY DEFINITION.  Also, by same protocol, two or more long bone fractures, BY DEFINITION, is major trauma.
2) Our state pediatric trauma protocol has a grayed box that states, and I am doing this from memory, something on the order of: Do not spend time on the scene doing the following assessments/treatments.  It then goes on to list stuff that comes before, and is more important than, splinting.

What drives me nuts is the "no life threatening injuries found".  Does that MEAN there are no life threatening injuries or that I didn't find them?  One major problem with major trauma is internal bleeding.  My understanding from the book is that kids show external signs of shock LATE and by the time they have decompensated you have screwed the pooch (ok, ok, there may be a better term for this, but it is late...).  SO, I figured you get them in the rig and on the way to definitive treatment ASAP.  The body and long board ARE splints, just not the best splints.  Of course, if there ISN'T internal bleeding, fine, stay and play. But isn't the point of BLS trauma protocals to admint that in the field we can't always know what is wrong?

Anyway, overall is was fine and I'm glad it is over.