Presentation on theme: "Best Best of of Med Flight Med Flight. Ken Heller Flight Nurse."— Presentation transcript:
Best Best of of Med Flight Med Flight
Ken Heller Flight Nurse
Scene Request Scene 21 sm. MVC
Single vehicle crash. Middle-aged patient. Lone Occupant of vehicle.
Wires Traffic Congestion Plowed field
Awake & alert. Confused. C/C pain in back, R leg, & Abd
Patient Open R ankle injury. Open L knee injury. Back pain. Right leg pain. Abdominal pain. Denied chest pain. Denied headache. Denied arm pain.
EMS Extricated. IV in R arm. Splint Immobilized –C-collar –Long board –CID EMS requested MF due to mechanism of injury and open Fxs. Normal BP. Tachycardia. Breathing normal.
Med Flight Patient awake & alert. Confused. No gross head trauma. Mental status waxes and wanes. Moves all fours. Hypotension noted. Pulses all fours. Fluid bolus. Behavior suggests CHI. C/C having to urinate and lying on long board.
ED Airbags deployed but slid underseatbelt? Not remember event. Must urinate. Pulses all fours. Open Fxs both legs.
Trauma Multiple rib Fxs. Open R ankle Fx. Open L knee dislocation. Pelvic dislocation/Fx. Burst Fx 4 th lumbar. Free air/fluid in Abd. To the OR with: Orthopedic Surgery. Vascular Surgery. Trauma Surgery
OR Exploratory laparotomy. –Splenectomy. –Repair –Bowel perforation –Mesenteric tears –Colonic tear Bradycardia with hypotension. Angiography of aorta: normal. Thoracotomy: normal cardiac function. Retroperitoneal hematoma. Developed irreversible coagulopathy.
Outcome Remained hypotensive. On many pressors. Returned to ICU for resuscitation. Pressors and blood products withdrawn. Patient died at Autopsy refused.
Scene Request 32 sm. MVC
Patient mid-20s. Intersecton T-bone
Patient Unrestrained. No LOC. Injuries to both legs. C/C leg pain. GCS 15. Remembered events.
EMS Prolonged extrication. Immobilized. Open and deformed right femur fracture. Left closed femur fracture. IV started. IV meds. –Fentanyl. –Versed. Reduced right tibia- fibula fracture and pillow splint. Left femur in Hare traction splint.
Med Flight Maintained Immobilization. Right leg remained in pillow splint. Left femur remained in Hare traction splint. Hare traction splint readjusted for helicopter. 12-minute flight.
ED Right tibia-fibula fxs. Left femur. Orthopedics consult. To OR.
OR R open tibia wound –Irrigation –Debridement –IM nailing L femur fracture –IM nailing
Outcome Discharged to a SNF for PT and assistance till on own.
Scene Flight 67 sm
Head-on motor vehicle crash Multiply victims
Patient Head-on crash with fatalities. Patient pinned in car. Extrication prolonged. Awake & alert. C/C bilateral lower extremity pain.
EMS Three victims pinned. Blast force at impact point. Debris spread out away from impact. One fatality. One transported by ambulance became second fatality.
Med Flight Patient still pinned by legs. When extricated; was slid onto a longboard. Immobilized. IV established. Placed on monitor. Mid hypotension. During flight received 1800cc. Heart rate slowed. Systolic BP 117. To ED for Trauma.
ED Multiply blood products to sustain BP. Taken to OR emergently. Trauma Surgery. Orthopedic Surgery. PVS Surgery.
OR Liver laceration. Subarachnoid hemorrhage. Fractures: –Right femur. –Left clavicle. –Right ribs. –Bilateral wrists. –Left toe. –Right orbital. To ICU. Second OR for abdominal closure.
Outcome Accepted in transfer at local hospital for Inpatient rehab.
Scene Flight 30 sm Mid-aged patient Motorcycle vs Auto
Patient Motorcycle rider. No helmet. Struck car head-on. Pain in left wrist. Pain in right ankle. Pain in pelvis.
EMS Immobilized. –C-collar. –Long board. –CID. –Splints. IV infusing. Oxygen by nasa cannula. Due to mechanism of injury & likely pelvis injury; Med Flight was called.
Med Flight Awake and alert. Examined briefly in roadway. Load and go. Closed left wrist fx. Closed right tib-fib fx. Possible back injury. Flight uneventful.
ED Trauma evaluation. Orthopedic eval. Sent to OR.
OR Intramedullary nailing of right closed midshaft tibia fx. Closed reduction & Percutaneous pinning of left distal radius fx.
Outcome Transferred to local hospital for rehab and PT.
46 sm 1 st day. Teenager Boating Accident
2 nd day Middle-aged patient Campsite stove explosion with burns
EMS Burns to: –Face. –Both upper extremities. –Both lower extremities. Wrapped in clean sheets. Requested MF for 3 rd degree burns.
Med Flight IV started. Fentanyl for pain. Flight uneventful Admitted to burn unit.
Burn unit 49% TBSA. Grafting of face and upper extremities. Month of burn care.
Outcome Discharged after a month to a SNF for further cares. Follow-up in burn clinic.
Scene flight 9 sm
Middle-age patient MVC
Watch for two sets of wires on the east side of the road! 1 2
Block traffic with a vehicle
Patient Stopped to turn and rear-ended. Multi-car crash Unrestrained back seat passenger. Doesnt speak English. Chest pain Extremity pain.
EMS Extricated. Immobilized. No observed LOC. Vital signs stable. Due to Mechanism of injury & inability to communicate; MF was requested.
Med Flight As rotors stopped; patient was being wheeled to us. Brief exam on EMS cot in roadway. Complaints of chest pain and extremity pain. Load and go. IV deferred for 3- minute flight. Placed on our monitor. Stable VS.
ED Right forehead abrasion. Parietal scalp hematoma. Right distal fibula fx. A non-traumatic thoracic aortic aneurysm. Trauma service. Orthopedic Team.
Outcome Admit for observation. Ortho placed the fibular fracture in a Bledsoe boot. Thoracic aortic aneurysm. Discharged home after two days. F/U ortho clinic. F/U Thoracic surgery clinic.