Special Edition: Signs Point to Fracture
Digest
This episode of EMS 2020 presents a special edition focusing on scenario-based learning, sponsored by Master of Medics. The hosts simulate a call to a trampoline park for a 10-year-old with a possible broken arm. The scenario details the dispatch, on-scene assessment on the unstable surface, C-spine stabilization, pediatric assessment, and management of an angulated arm fracture. Key interventions include intranasal fentanyl for pain, gentle arm repositioning to restore circulation, and splinting. The discussion highlights challenges of the environment, patient and parent interaction, and the decision to transport to a Level 1 Trauma Center. The episode concludes with a debrief on performance, alternative approaches, and critical considerations for limb compromise and pediatric pain assessment. Promotional content for EMS 2020's continuing education platform and Master of Medics' scenario books is also included.
Outlines
Introduction and Support
The podcast begins with a humorous crisis of the host being out of coffee, followed by promotions for EMS 2020 merchandise, specifically mugs, and their continuing education platform, which offers CE credits for listening to episodes.
Special Edition: Scenario-Based Learning with Master of Medics
This special edition focuses on analyzing patient scenarios from "Master of Medics" books. The format involves one host presenting a scenario for the other to navigate, emphasizing that protocols may differ and the content is for educational purposes.
Scenario Setup: Dispatch to Extreme Jump
The scenario begins with dice rolls determining the paramedic's partner and work environment. A dispatch is received for a trampoline center regarding a 10-year-old with a possible broken arm, with the crew running behind due to a slow partner.
On-Scene Assessment and Initial Management
The crew arrives at the trampoline park and assesses the crying child with an angulated arm. They prioritize safety on the unstable surface, apply a C-collar, and use the PALS triangle for assessment, noting pallor distal to the angulation.
Fracture Management, Pain Control, and History
The paramedic explains the plan to the patient and father, applies a child-sized C-collar, and gathers history, including reports of back pain. The team prepares for repositioning and back assessment, using trauma shears and palpating for tenderness.
Preparing for Transport and Patient Interview
The patient is placed on a backboard for assessment on a stable surface, with vital signs taken and a cardiac monitor applied. The patient describes the injury mechanism, and a SAMPLE history is gathered, noting asthma as the only significant medical history.
Pain Management and Splinting Techniques
Intranasal fentanyl is administered for pain relief before arm repositioning. A unique splinting method using a cardboard box is described, followed by reassessment of vitals and pain level.
Successful Realignment and Transport Decision
Gentle traction is applied to realign the fractured arm, resulting in an immediate return of color and confirmed radial pulse. The patient remains tearful but stable, and the decision is made to transport to the Level 1 Trauma Center.
Ambulance Transport Preparation and Radio Report
The fire department assists with moving the patient onto the gurney. The plan includes reassessing the limb, establishing IV access, and preparing a detailed radio report for the receiving hospital.
Scenario Debrief and Performance Review
The hosts debrief the scenario, discussing the effectiveness of the coaching, on-scene interactions, and the challenges of the trampoline park environment. Strengths and alternative approaches are reviewed.
Critical Considerations and Educational Wrap-up
The discussion covers treatment adjustments for limb compromise, the correct use of the faces pain scale for children, and the importance of pre-transport communication and reassessment. Episode wrap-up includes sponsor mentions.
Keywords
EMS Continuing Education
EMS 2020 offers a continuing education platform where listeners can earn CE credits by listening to podcast episodes. This provides a convenient and accessible way for EMS professionals to maintain their certifications.
Master of Medics
Master of Medics provides patient scenario books and add-ons used in this podcast's special edition. These resources are valuable tools for EMS training and scenario-based learning.
Pediatric Assessment Triangle (PALS)
A rapid assessment tool used in pediatrics to evaluate a child's condition based on appearance, work of breathing, and circulation. It helps prioritize interventions in emergency situations.
Angulated Arm Fracture
A fracture where the bone is bent or angled. This type of injury often requires reduction (straightening) to restore proper alignment and improve circulation.
Distal CMS (Circulation, Motor, Sensory)
Refers to the assessment of blood flow, movement, and sensation in the extremities. Intact distal CMS is crucial after an injury or intervention to ensure adequate circulation and nerve function.
Intranasal Fentanyl
Fentanyl administered through the nasal passages. This method is effective for rapid pain relief in pediatric patients, especially when IV access is difficult.
Limb-Threatening Injury
An injury that compromises the viability of a limb, such as a fracture with compromised circulation. Prompt intervention is necessary to prevent permanent damage.
Scenario-Based Learning
An educational approach that uses realistic scenarios to teach and assess skills. This method is highly effective for emergency medical services training, allowing for practice in a simulated environment.
Faces Pain Scale
A pain assessment tool used primarily for children, featuring a row of faces ranging from happy to crying, allowing patients to point to the face that best represents their pain level.
EMS Education
Educational resources and materials for Emergency Medical Services professionals, covering scenarios, best practices, and advanced medical knowledge to improve patient care.
Q&A
What is the EMS 2020 continuing education platform?
The EMS 2020 continuing education platform allows listeners to earn CE credits by listening to podcast episodes. It offers unlimited access to CE credits for a yearly subscription fee, providing a convenient way for EMS professionals to maintain their certifications.
What is the "Be Don't Stay" special edition of EMS 2020?
This special edition focuses on analyzing patient scenarios from "Master of Medics" books. One host presents a scenario, and the other navigates through the assessment and treatment, providing an educational and engaging format for learning.
What are the key considerations when assessing a pediatric patient with a suspected fracture in a trampoline park?
Key considerations include the unstable surface, potential for further injury, the need for careful patient and equipment movement, and applying pediatric assessment principles like the PALS triangle. Pain management and ensuring distal circulation are also critical.
How was the angulated arm fracture managed in the scenario?
The paramedic assessed distal circulation, which was compromised. After explaining the procedure and administering intranasal fentanyl for pain, they gently repositioned the arm to restore blood flow and then splinted it using a unique cardboard box method.
Why was the patient transported to a Level 1 Trauma Center instead of a closer Level 3 hospital?
Although the initial injury seemed manageable at a Level 3, the hospital expressed concern that imaging might reveal more complex issues beyond their capabilities. Therefore, transport to the Level 1 Trauma Center was deemed more appropriate for comprehensive care.
What are the critical considerations if CMS restoration to a limb is unsuccessful?
If CMS restoration fails, the treatment plan would likely involve stabilizing the limb and proceeding to a trauma center due to the high risk of limb loss or developing nerve palsy from prolonged circulation cutoff.
How should the "faces" pain scale be used correctly with children?
The faces pain scale should be used by having the child point to the face that best represents their pain level. It's not about matching their current facial expression to a picture.
Why is pre-transport communication with the receiving hospital important in limb compromise cases?
Contacting the receiving hospital, especially a level three trauma center, ensures they are prepared for the specific case, like a limb with temporary circulation loss, allowing for a smoother and more effective transfer of care.
Where can listeners find resources mentioned in the episode?
Listeners can find the "100 Patients Scenarios" books and add-ons at MasterYerbaix.com, and other educational insights at EMS2020.com.
Show Notes
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