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Thread: Homicide Rates vs Trauma Care

  1. #31
    THE THIRST MUTILATOR Nephrology's Avatar
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    Quote Originally Posted by Sensei View Post
    ...especially when the tube lands in the esophagus.
    but that would never happen, right?

  2. #32
    Quote Originally Posted by Nephrology View Post
    but that would never happen, right?
    Looked at that link.

    IIRC, we were taught to auscultate the stomach region, then bilaterally at three points up and down aligned with the nipples. Was this not done in the field cases?

    This gave me some pause:

    Asselin’s research assistant stumbled upon the problems with patients’ breathing tubes in July 2018, while studying the effects of a new state protocol for cardiac arrest patients.

    Asselin wanted to see whether the “30 minute rule” — which requires EMS personnel to spend at least a half an hour on scene performing CPR before taking them to the hospital — had improved patients’ chances of surviving a cardiac arrest neurologically intact. (Preliminary results were promising; the study is ongoing.)


    I'm certain there isn't enough context in that snippet, could someone enlarge on the practice?

  3. #33
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    Auscultation has a high risk failure in detecting esophageal intubations (up to 15%).

    End-tidal Co2 monitoring for ET tube placement confirmation should be standard of care at this point. There is some movement to do ET tube confirmation with US but that presents a whole new training issue for prehospital medicine.

    Why we are so fixated on endrotrachael tubes is also an interesting question. Despite the dogma that supraglottic airways might increase risk of gastric aspiration, recent studies have show them to at least be no worse (I-Gel) and perhaps even better (King) in working field arrests with no difference in complications.

  4. #34
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    Arrow

    I started in EMS in the early 80’s we didn’t wear gloves back then, rinsed off our BVMs and Laryngoscopes and washed them between calls-gross! I always thought the no tourniquet rule was missing the mark. Also, MUCh can be done with little equipment and more experience, especially the closer you are to definitive care. 2 Quick tips, you can get total control of lower limb bleeding by simply holding firm digital (finger) pressure on the femoral artery. Often times simply opening the mouth and pulling the jaw forward will allow the patient to start breathing. This from 38 years of doin it. Most get lost in “ how do I needle the chest” and other crap, where attention to good basics will pay way more dividends.

    Unit 407 4 min out obtunded, intubated, palpable pressure of 60, HR 150. ballistic injury to left thorax and RUQ abdomen.

    Arrives in bay: No palpable pulse, cpr in progress, Left thoracotomy with open massage intra cardiac epi, cross clamp bleeding aorta return of circulation, still hypotensive HR 130, whole blood continues. All that was about 3-4 minutes. Midline abdominal incison, with gross blood, towels to pack a Grade 3 liver injury. 3 or 4 minute. To the main OR where he hopefully won’t bleed to death, then he has to make it through the next 24 hours in the trauma ICU.

    Despite great care being shot is a crap shoot, some of these are impossible to fix. Lesson 1, do your utmost not to get shot: be NICE, walk away, think positive, be positive. Second lesson: never get shot when your mor than 10 minutes from a level one trauma center!

    Dave

    Dave

  5. #35
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    “As a trainer it was always somewhat disheartening to realize that the basic things you preached were ignored in the field - officers run their first year off what they got from academy and FTO's they run their second year off their peers and their experiences in the first year, and so on. Each year it seems they shed basic safety rules because they haven't experienced bad things happening. As the saying goes, one year of experience, repeated twenty times.” -Dan Lehr

    That is an outstanding explanation! Especially if you have spent your career (as I have) in communities that are economically and socially stable and don’t usually have a lot of violent street crime to deal with.

    When you’re responding to the same dozen calls over and over again, and the seriousness and variety of the calls are limited in comparison to the experiences of an officer or deputy in a busier jurisdiction, it’s easy to become unconsciously complacent.

  6. #36
    Member John Hearne's Avatar
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    Quote Originally Posted by Jeff22 View Post
    “As a trainer it was always somewhat disheartening to realize that the basic things you preached were ignored in the field - officers run their first year off what they got from academy and FTO's they run their second year off their peers and their experiences in the first year, and so on. Each year it seems they shed basic safety rules because they haven't experienced bad things happening. As the saying goes, one year of experience, repeated twenty times.” -Dan Lehr
    That is an outstanding explanation! Especially if you have spent your career (as I have) in communities that are economically and socially stable and don’t usually have a lot of violent street crime to deal with.
    When you’re responding to the same dozen calls over and over again, and the seriousness and variety of the calls are limited in comparison to the experiences of an officer or deputy in a busier jurisdiction, it’s easy to become unconsciously complacent.
    I find it utterly depressing how the list of 10 reason why officers are feloniously killed in the line of duty remains unchanged for decades.....
    • It's not the odds, it's the stakes.
    • If you aren't dry practicing every week, you're not serious.....
    • "Tache-Psyche Effect - a polite way of saying 'You suck.' " - GG

  7. #37
    Bumping for an informative thread.

    Any opinions of how "right" tecc gets it? It always seems 1 or 2 sections more "progressive" than phtls.

    Asking as a guy that works rural ems with no medics and 120 miles from a level 3,2 or 1 trauma center.
    EMS, Rescue, Fire, fun stuff

  8. #38
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    So would it be safe to say that a takeaway from Mr. Givens' original post is that homicide rates are a lousy indicator of trends over time in actual incidence of violent crime, and that instead aggravated assault may be a much better indicator?

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