The call was simple when it came in, a man has fallen and is bleeding.
As you climb the granite steps, they are narrow and steep and so far each one is covered in spots of bright red blood. As you step carefully around the spots and up to the third switch back you find your patient standing in the corner, head laceration over the right eye, slurred speech and a wicked flail chest. He's 83.
He's grasping onto the railings at a turn in the stairs, barely enough room for you to pass by and survey from above.
Similar to this photo from a hotel somewhere, the fellow with the red spot on his face is your patient, just imagine him standing straight up in the corner. The stairs down around the corner are just as steep and narrow as the stairs here.
How will you deal with C-Spine precautions, if at all?
You make the call.
Comments
One you could "clear the c-spine if possible and walk him down, the question is he likley to pass out and or fall again even with assistance?
Two you could clear the c-spine and put him in a stair chair and carry him down.
Three you could do a standing take down with a ankle hitch and webbing seat to keep him from sliding down the board if you think you have enough room and he will let you lie him flat with that flail chest.
Four you could place him in a KED while standing and then carry him down in a stair chair.
Five you could call for a ladder and place him in a stokes with LSB and take him out the window but again he would need to lie flat for that.
No real Good and eazy options exist.
One you could "clear the c-spine if possible and walk him down, the question is he likley to pass out and or fall again even with assistance?
Two you could clear the c-spine and put him in a stair chair and carry him down.
Three you could do a standing take down with a ankle hitch and webbing seat to keep him from sliding down the board if you think you have enough room and he will let you lie him flat with that flail chest.
Four you could place him in a KED while standing and then carry him down in a stair chair.
Five you could call for a ladder and place him in a stokes with LSB and take him out the window but again he would need to lie flat for that.
No real Good and eazy options exist.
One you could "clear the c-spine if possible and walk him down, the question is he likley to pass out and or fall again even with assistance?
Two you could clear the c-spine and put him in a stair chair and carry him down.
Three you could do a standing take down with a ankle hitch and webbing seat to keep him from sliding down the board if you think you have enough room and he will let you lie him flat with that flail chest.
Four you could place him in a KED while standing and then carry him down in a stair chair.
Five you could call for a ladder and place him in a stokes with LSB and take him out the window but again he would need to lie flat for that.
No real Good and eazy options exist.
First, you need full c-spine and in my opionon you are not really gettting it from the KED/Stair chair, plus the KED is gonna cause a LOT of discomfort for that chest and possibly compromise breathing.
So I'm thinking we get him on a board on the stairs and then into SKED (if you are not familiar, Just google SKED). These put lots of handles on the patient, accommodate the board, collar, headblock setup, and hold the patinet snugly in. You can do a vertical lift, stand him straight up if you need to, or lower him out a window. We carry these on our rescue. Hazmat team use the hazmat version for bragging a patients out to the decon area. Ours is a rescue variety which could be the perfect choice for this call because it gives the best protection for the patient and keeps him totally stable no matter what position. Before the final lacing up, I'd try getting a pillow in on the patients chest to see if that helps with the breathing.
Main medical concerns here are his breathing (proper end tidal CO, and O2 sats?), his altered mental status and when it started (possible CVA prior to the fall?), possible head injury (the head lac is just a distraction, cover it when you have time and move on).
I am staying away from the stair chair because it is very difficult to make those turns with all the handles and tracks sticking out. I am also not liking the idea of sliding the board because of the additional trauma that could be induced to the spine.. Remember, even though he is tied down, the bones still rub and scrape with each start and stop or thump on the stairs.
This is a challenging one. I think any of the solutions might work if executed carefully. I'm not suggesting others made bad choices, I'm just trying to share what is in my mind as I think it through. I'm wondering what all of you are thinking about the priority of injuries?
Justin you didn't say if this is an open type stairwell? If it is, this becomes much easier. Go up one floor and anchor your line to drop right down the center of the stairwell. Set the SKED up to hang the patient horizontally and get him at waist height then just walk him down suspended. One firefighter lets out the belay as you descend and all the rescuers do is guide him as he floats down. The photograh does not look like the written description. An open stairwell would be easier.
OK, so now do I look stupid, or did I get you thinking?
First, you need full c-spine and in my opionon you are not really gettting it from the KED/Stair chair, plus the KED is gonna cause a LOT of discomfort for that chest and possibly compromise breathing.
So I'm thinking we get him on a board on the stairs and then into SKED (if you are not familiar, Just google SKED). These put lots of handles on the patient, accommodate the board, collar, headblock setup, and hold the patinet snugly in. You can do a vertical lift, stand him straight up if you need to, or lower him out a window. We carry these on our rescue. Hazmat team use the hazmat version for bragging a patients out to the decon area. Ours is a rescue variety which could be the perfect choice for this call because it gives the best protection for the patient and keeps him totally stable no matter what position. Before the final lacing up, I'd try getting a pillow in on the patients chest to see if that helps with the breathing.
Main medical concerns here are his breathing (proper end tidal CO, and O2 sats?), his altered mental status and when it started (possible CVA prior to the fall?), possible head injury (the head lac is just a distraction, cover it when you have time and move on).
I am staying away from the stair chair because it is very difficult to make those turns with all the handles and tracks sticking out. I am also not liking the idea of sliding the board because of the additional trauma that could be induced to the spine.. Remember, even though he is tied down, the bones still rub and scrape with each start and stop or thump on the stairs.
This is a challenging one. I think any of the solutions might work if executed carefully. I'm not suggesting others made bad choices, I'm just trying to share what is in my mind as I think it through. I'm wondering what all of you are thinking about the priority of injuries?
Justin you didn't say if this is an open type stairwell? If it is, this becomes much easier. Go up one floor and anchor your line to drop right down the center of the stairwell. Set the SKED up to hang the patient horizontally and get him at waist height then just walk him down suspended. One firefighter lets out the belay as you descend and all the rescuers do is guide him as he floats down. The photograh does not look like the written description. An open stairwell would be easier.
OK, so now do I look stupid, or did I get you thinking?
Capt. Tom
Capt. Tom
Capt. Tom
Capt. Tom