RE: Scenario--(was First Responder)

[Guest guest]

Rapid transport and appropriate treatment. He might have blown off some

weird portion of his brain that isn¡Çt absolutely necessary for a

semi-productive life. If you have a pulse, then you have a transport. I

won¡Çt discount those things that I have no control over.

Mike

Scenario--(was First Responder)

You arrive at a residence to find a 21 year old male who has placed the

barrel of a 12 gauge shotgun to his forehead just above the nose and pulled

the

trigger. The entire top of his skull has been blown away, and there is a

perfect

V-shaped skull avulsion from the tip of the nose upward.

Brain matter is on the wall and ceiling, with scalp hanging at the back of

the skull. The orbits and sella turcica are visible as is the medulla.

The patient has respirations of 3-4 per minute and a steady radial pulse of

exactly 72. This pulse and respiratory rate continue.

What to do?

(Based upon a real case).

Gene G.

[Guest guest]

Gene,

This patient should be worked to the full extent of your systems capability.

It sounds like the patient¡Çs brain stem is still intact. If nothing else,

you have an excellent source organ for transplants

Naughton

Scenario--(was First Responder)

You arrive at a residence to find a 21 year old male who has placed the

barrel of a 12 gauge shotgun to his forehead just above the nose and pulled

the

trigger. The entire top of his skull has been blown away, and there is a

perfect

V-shaped skull avulsion from the tip of the nose upward.

Brain matter is on the wall and ceiling, with scalp hanging at the back of

the skull. The orbits and sella turcica are visible as is the medulla.

The patient has respirations of 3-4 per minute and a steady radial pulse of

exactly 72. This pulse and respiratory rate continue.

What to do?

(Based upon a real case).

Gene G.

[Guest guest]

Transport.

EMS for Life

Scenario--(was First Responder)

You arrive at a residence to find a 21 year old male who has placed the

barrel of a 12 gauge shotgun to his forehead just above the nose and

pulled the

trigger. The entire top of his skull has been blown away, and there is

a perfect

V-shaped skull avulsion from the tip of the nose upward.

Brain matter is on the wall and ceiling, with scalp hanging at the back

of

the skull. The orbits and sella turcica are visible as is the medulla.

The patient has respirations of 3-4 per minute and a steady radial pulse

of

exactly 72. This pulse and respiratory rate continue.

What to do?

(Based upon a real case).

Gene G.

[Guest guest]

I agree, provide supportive measures and notify Life Gift. Transport for

evaluation for organ donor potential.

, Director

Seminole EMS

Seminole, TX. 79360

(432)758-8816

(432)758-6533 fax

Scenario--(was First Responder)

You arrive at a residence to find a 21 year old male who has placed the

barrel of a 12 gauge shotgun to his forehead just above the nose and pulled

the

trigger. The entire top of his skull has been blown away, and there is a

perfect

V-shaped skull avulsion from the tip of the nose upward.

Brain matter is on the wall and ceiling, with scalp hanging at the back of

the skull. The orbits and sella turcica are visible as is the medulla.

The patient has respirations of 3-4 per minute and a steady radial pulse of

exactly 72. This pulse and respiratory rate continue.

What to do?

(Based upon a real case).

Gene G.

[Guest guest]

I suggest placing him on a back board with lots of towels under the back of

his head and placing him on 3 lpm low flow blow by o2 and transporting him

to the hospital for there evaluation. Have the family removed to a closed

room first. This could be a long drawn out ordeal .

Scenario--(was First Responder)

> You arrive at a residence to find a 21 year old male who has placed the

> barrel of a 12 gauge shotgun to his forehead just above the nose and

pulled the

> trigger. The entire top of his skull has been blown away, and there is a

perfect

> V-shaped skull avulsion from the tip of the nose upward.

>

> Brain matter is on the wall and ceiling, with scalp hanging at the back of

> the skull. The orbits and sella turcica are visible as is the medulla.

>

> The patient has respirations of 3-4 per minute and a steady radial pulse

of

> exactly 72. This pulse and respiratory rate continue.

>

> What to do?

>

> (Based upon a real case).

>

> Gene G.

>

>

>

[Guest guest]

Remember do the basic he may be a donor and the family needs to know you did

all you could do for him .

Scenario--(was First Responder)

> You arrive at a residence to find a 21 year old male who has placed the

> barrel of a 12 gauge shotgun to his forehead just above the nose and

pulled the

> trigger. The entire top of his skull has been blown away, and there is a

perfect

> V-shaped skull avulsion from the tip of the nose upward.

>

> Brain matter is on the wall and ceiling, with scalp hanging at the back of

> the skull. The orbits and sella turcica are visible as is the medulla.

>

> The patient has respirations of 3-4 per minute and a steady radial pulse

of

> exactly 72. This pulse and respiratory rate continue.

>

> What to do?

>

> (Based upon a real case).

>

> Gene G.

>

>

>

[Guest guest]

,

I just want to know where you came up with 3LPM O2 by blow-by?!? Why not 2?

Why not 4? Why not 15? Why blow-by as opposed to direct mask placement?

Mike

Re: Scenario--(was First Responder)

I suggest placing him on a back board with lots of towels under the back of

his head and placing him on 3 lpm low flow blow by o2 and transporting him

to the hospital for there evaluation. Have the family removed to a closed

room first. This could be a long drawn out ordeal .

[Guest guest]

I would work this patient to the max, mindful of scene safety and crime scene

preservation, to the best of the crew's ability. As sad as it sounds, this

sounds like an organ donor situation, with the info available.

If there is a supervisor or someone 'official' that can transport the NOK (if on

scene)in a separate vehicle, please do so. There are some decisions that may

have to be made in a short period of time, and having the NOK at the hospital

will facilitate this.

Also, the family can be reassured that the best possible was done for their

loved one in a horrible situation.

Larry RN LP EMSI

[Guest guest]

Evidently you have never worked a frontal eyebrow level shot gun blast to

the head. He is breathing out the top of the wind pipe that is visible and

the brain cortex and cerebellum above the medulla is gone or hanging out the

back of his head and possible still attached the 3 is jus a figure as you

will not get much in unless you intubabated,there is no oral farinix or

sinuses or nasal sub structure you need to intubabate it is very easy matter

of just sticking a tube straight down the un obstructed wind trash.

Generally I would try to support basic life support this type of injury is

not constant with survival for long periods of time usually 90 % of he brain

is on the wall and no skull cap is left. The idea is to support his family

and possible organ donation keep it simple and go . If you are transporting

I suggest an iv and you need to do the advance options you start cpr and bag

with a et tube in place you cant use a combie tube on this one, advance

options are now things for the hospital to do. There is no definitive course

of action you can take other than basic and trans port. Now back to the air

way it is open at the top but I would not want to attempt to intubabate

there as in the last several that I have taken to the hospital the dr did

not intubabate either as the air way is quite open and clear, the o2 is just

what they did to support the pt until death. I am not a dr and we don't have

protocols covering no brain from the medulla up so I went real basic I did

do lines on the last one as I was a paramedic on it I was basic on the other

two and so was every body else in 200 or more miles. these type of calls

require out of the box thinking and maneuvers you have never been trained in

like moving the attached brain parts with the body so they don't detach.

Re: Scenario--(was First Responder)

>

>

>

> I suggest placing him on a back board with lots of towels under the back

of

> his head and placing him on 3 lpm low flow blow by o2 and transporting him

> to the hospital for there evaluation. Have the family removed to a closed

> room first. This could be a long drawn out ordeal .

>

>

>

>

>

>

[Guest guest]

Support the shell (the Patient has long since left) and let the next of kin

decide whether or not to donate organs.

TD

Scenario--(was First Responder)

>You arrive at a residence to find a 21 year old male who has placed the

>barrel of a 12 gauge shotgun to his forehead just above the nose and pulled

the

>trigger. The entire top of his skull has been blown away, and there is a

perfect

>V-shaped skull avulsion from the tip of the nose upward.

>

>Brain matter is on the wall and ceiling, with scalp hanging at the back of

>the skull. The orbits and sella turcica are visible as is the medulla.

>

>The patient has respirations of 3-4 per minute and a steady radial pulse of

>exactly 72. This pulse and respiratory rate continue.

>

>What to do?

>

>(Based upon a real case).

>

>Gene G.

>

>

>

[Guest guest]

Gene,

I agree wholeheartedly with , transport, if for no other reason, you

have an excellent chance for organ harvest.

Mike H

> Gene,

>

>

>

> This patient should be worked to the full extent of your systems

capability.

> It sounds like the patient¡Çs brain stem is still intact. If nothing

else,

> you have an excellent source organ for transplants

>

>

>

> Naughton

>

> Scenario--(was First Responder)

>

>

>

> You arrive at a residence to find a 21 year old male who has placed the

> barrel of a 12 gauge shotgun to his forehead just above the nose and

pulled

> the

> trigger. The entire top of his skull has been blown away, and there is a

> perfect

> V-shaped skull avulsion from the tip of the nose upward.

>

> Brain matter is on the wall and ceiling, with scalp hanging at the back of

> the skull. The orbits and sella turcica are visible as is the medulla.

>

> The patient has respirations of 3-4 per minute and a steady radial pulse

of

> exactly 72. This pulse and respiratory rate continue.

>

> What to do?

>

> (Based upon a real case).

>

> Gene G.

>

>

>