Impaled by branch

Steve Connally said:
Not to contradict your assessment but ringers isn’t a standard of care for volume replacement anymore. Blanket fluid boluses have been proven to decrease survival. Tends to thin the blood and wipe out the clotting functions. Big shift in fluid replacement about 15 years ago. Standard is now 250cc blouses of normal saline to maintain a systolic BP of 90. Your assessment is solid though.
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Very cool, yes this stuff is always changing and evolving, and I’ve been out of that game since 06. Still fascinates me though.

Think that gray material on his front is just part of his shirt? Just wondering if it could be something to stop sucking.
 
Damn. Looking back that’s really frightening. Filling people up with ringers was our go to until they could get real blood.
 
Bango Skank said:
Damn. Looking back that’s really frightening. Filling people up with ringers was our go to until they could get real blood.
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It was for us too. We even did a synthetic blood study for a couple years. It didn't pan out but we had it on the truck and occasionally used it. I remember hanging bag after bag of ringers with a pressure infuser on one bag and a bp cuff on the other and just filling them up. I was also in the game back when we used MAST Trousers LOL Showing my age I think
 
Steve Connally said:
It was for us too. We even did a synthetic blood study for a couple years. It didn't pan out but we had it on the truck and occasionally used it. I remember hanging bag after bag of ringers with a pressure infuser on one bag and a bp cuff on the other and just filling them up. I was also in the game back when we used MAST Trousers LOL Showing my age I think
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What are they doing wrong now that they'll figure out in the near future?
 
Steve Connally said:
I was also in the game back when we used MAST Trousers LOL Showing my age I think
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I remember those, trained to use them in 99 at Fort Sam Houston then never saw them again.

SomethingWitty said:
What are they doing wrong now that they'll figure out in the near future?
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I’ve read a little about The Canadian C Spine Rule, and if I’m understanding it right, it’s saving countless hours of work and waiting and saving people some cash on unnecessary X-ray costs. Really simple and if applied under the right circumstances the error rate is often around 0%.
 
Steve Connally said:
Wow, who knows. Thats a loaded question!!!
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Maybe. It's just strange for those of us who aren't paramedics to see how recently something similar to volcano mulching was a standard practice on humans.
I just didn't assume that patient care on the way to the hospital was still evolving the same way that other things are. I should have, but I'd never given it much thought.
 
My clown suit's ready for action!

Weighing in at just under 3 lbs.

Three lbs of prevention could save your 200 lb azz.....

Jemcoimage.webp
 
Do you seriously whip out your handsaw like a ninja sword? Better not miss the sheath...
This is not helping the somber tone in here.
I cant imagine what this guy has gone thru, if I try I start twitching. So much ouch, def not funny. Although I will say the paramedics don't model the humorless response very well, "big splinter?"
 
So beyond stabilizing, how does a surgeon get that out? I assume they'd cut it first??? How without making a lot of dust? (or is the dust not a concern?) What do they have in a hospital to cut a big chunk of wood?
 
A three piece bull riding vest saved my azz from multiple broken ribs when my sloppily tied block came undone and the anchoring rope lashed me across the back hard enough to knock all the wind out of me, leaving a black n blue stripe across my back for weeks.

Now I know why timber hitch wraps need to exceed well over half the trunk's circumference!

Particularly when negative blocking big wood!

I learned my lesson well, and painfully.

The handsaw's in a boot scabbard, of course.

Jemco
 
rope-a-dope said:
This is not helping the somber tone in here.
I cant imagine what this guy has gone thru, if I try I start twitching. So much ouch, def not funny. Although I will say the paramedics don't model the humorless response very well, "big splinter?"
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I drive our ambulance as little as possible (hits too close to home), but when I do the chatter is rarely somber post call. Appears after lots of the same experience there is more humor, especially dark humor. Humors are hard to keep balanced I've heard... Other's pain and suffering is never taken lightly, just coped with and processed differently.
 
Yeah, the gallows humor kinda helps some of them keep something similar to sanity. They’re usually pretty good about not saying the wrong thing within earshot of the public though. Doctors, nurses and cops do it too at times. Firefighters just utilize quantities of brown liquor. Kidding!
Sometimes they’ll get a cheap tasteless laugh so they don’t cry and lose focus and stop coming to work. It’s bizarre, yes, but it’s a coping mechanism that keeps them doing what needs to be done, and it doesn’t always work and doesn’t always come up. It’s really tough sometimes and can haunt these men and women long after it’s over. Shit involving friends or children screwed me up before.
 
SomethingWitty said:
Maybe. It's just strange for those of us who aren't paramedics to see how recently something similar to volcano mulching was a standard practice on humans.
I just didn't assume that patient care on the way to the hospital was still evolving the same way that other things are. I should have, but I'd never given it much thought.
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Oh its evolving at lightning speed. Look at the changes in the CPR standards. They have actually come full circle from when I started. Also we practiced toss them in the truck and drive as fast as possible getting as much as you can get done enroute. Now the standard is stabilize then transport. We used to work cardiac arrests the same way. Now we work them where they are for extended periods of time and if treatment doesn't work the code gets called in the field. Reduces taking dead people to the er to say they are dead. Still feels really odd to spend 30 minutes on a living room floor working someone where we used to be on the road and at the hospital in that time. What they learned is generally after the initial therapy protoclols, if they haven't been resesutated they won't be in the er either. I've watched a ton of things change over a few decades. They change the drugs and the treatments we do frequently. When you be come the old dog, it gets difficult to memorize all the changes. The technology was advancing in the field like ultrasounds and advanced clinical measures. Some time after the trend started to pull the other way. It comes in waves. Do tons in the field, then do a little but just get them to the er. Its very cyclical and feels like a period of education and advancement followed by a period of dumbing down. One point has always remained constant.......No matter how good you are or how advanced your gizmos are-------you just can't cure dead. Srs, Mrs, dDrt, SRT, old school, new school, twin line, single line.........were still climbing trees. In prehospital medicine the things change. Studies are done to see what effect it's had on long term survival and then after much evaluation those practices are changed, scrapped, or continued. It takes time. Look at my crane. They've been around a while but nobody really knows the lifespan operating the way we are using them now. Years from now somebody will evaluate it and make a change or at least push for a change. Magnify that by millions of times over when you consider the human organism and how the body reacts to certain treatments. You are probably too young to remember when saccharin was the next best thing for your body instead of sugar. Well that was an epic fail. Who knows when they will actually prove beyond a shadow of a doubt all the shit they put in our food is in fact killing us off new disease by new disease. People know it now but its not widely accepted yet. I had read about arborists in texas painting elm pruning cuts because the seasons out there never actually allow the dormancy needed to be able to prune at a disease resistant stage in the tree. Now painting pruning cuts is ok again in some places. Crazy how things come around again.
 
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Bango Skank said:
View attachment 62370

Any current, former, or wannabe medical pros or trauma junkies wanna take a crack at those questions?

All just theoretical discussion on my part here. I’ll bet the paramedics are gonna load him up and haul ass ASAP. The sooner that guy is in front of a surgeon, the better chance he has of surviving. If the branch is moving around some and aggravating the wound they’d probably stabilize it with some bulky dressings before moving him. They’ll evaluate c spine and immobilize if possible... face or jaw injury or compromised airway might not let the c collar happen. I see a dressing there too. He’s sitting up though so airway is probably good.
Their biggest concern is probably shock which could come from blood loss. Could come from other causes but my money is on low blood volume. Where the blood loss comes from is gonna take a doctor and some expensive gear to figure out. Possibly internal bleeding, maybe lung injury, maybe head injury, maybe neck and spine injuries. I’ll bet dude was in some respiratory distress. Chest trauma can have a lot going on, could be multiple injuries and all of them could be life threatening including actual cardiac trauma.

We see the branch where it enters and exits, but very possible it started at a different angle and took a hard turn as his body position changed when he hit the ground/ object.

They’d take care to not move him anymore than they have to, but he’s gotta be moved. Spine board probably isn’t happening with the branch there. Watch blood pressure closely during transport it’s a solid indicator of shock. Also o2 with NRB and watch o2 sat and listen for lung function. Probably big bore IV catheter in each arm and give ringers lactate fluid to add blood volume. Even if he doesn’t need it, it won’t hurt. Also ER will appreciate having access already.

Who knows, the ambulance might be skipping the closest ER and meeting a helicopter in a parking lot. Some hospitals are much better prepared to handle this than others. Some air ambulance have a surgeon on the crew too.

Not much info given, there’s lots of stuff that could be going on that we can’t tell from the one pic. All the pics in the world can’t tell us everything.

Sitting up in the pic though is good. If he lives through surgery, he has a chance. Poor guy, that has to be excruciating.
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Damn!
 
jimbo666 said:
Damn!
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Talk to him #1 and keep him calm and awake. Stoping the bleeding would be nice but can be very difficult with a entering and exiting wond. he might want water after alot of blood loss but that could cause nausea and vomiting unfortunately no food or water when we get close to shock ☹️. Haveing the blood go to your stomach in a demanding moment can make you pass out.
Surgery is definitely needed to avoid any further nerve damage do not pull it out on your oun! I'm sending positive thoughts to him and his family
 
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