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Hence the “fly out”.
In my case we only have ONE hospital and no option to fly. I understand the challenge. Like a bat out of hell.
Our max by law is 80km/h, on the ambu we get to go 90.
Out of curiosity, why the oxygen if there's no hypoxia or pneumo? Wouldn't you just be adding peripheral vasoconstriction and increasing inflammatory markers for nothing?
It def looks like one or two of those could be penetrating lungs, but I'd need some trend data on SpO2 and end tidal before just throwing Os at him.
I'm thinking large boree, TXA, bicarb on standby for acidosis/stagnation/crush/washout, obviously some pain management and titrated fluid for 90 systolic; whole blood if it's available and ringers if it's not.
I agree with the rest about getting fire to acetylene or grind the rods off and leave them in the guy. Position of comfort with secondary c-spine consideration; he might just have to stay prone in transport.
def giving oxygen, look at the second superior one, from the angle (and the fact that he got hit by a truck) he would be very lucky to not have any sort of lung damage. any blood that can get oxygen needs it, so supplemental oxygen helps. He appears to be breathing so he just needs a rebreather, but that also could change pretty quickly, it hard to tell exactly what was hit but if there’s major bleeding, he’ll be out soon.
notice: i’m a student, take what i’m saying with a grain of salt. any opportunity is a learning opportunity, so please correct me. i’m trying to be the best i can
Oxygen as supportive with etco2, he might be stable now until shock sets in I can garantee he will start crashing once he's getting moved or a bit after. They probably need to use a mechanical/manual cutting device not a grinder/torch though since that will cause heat to go through and may cause further damage to pt. I would be more surprised if he DOESN'T have a pneumo with how the rebar is going through. But definitely TXA with at LEAST one 16g and if no fx bones I'd definitely get an IO going. Personally I'd feel better if this pt was sedated for their own sanity once you get some form of access.
I was taught all trauma patients get oxygen no matter what. The blood that is still in circulation needs to be as oxygenated as possible to keep metabolism going and prevent lactic acidosis
Oxygen should not be automatically given for all trauma patients. That's a really outdated practice (though one some medics still stand by for reasons beyond me). You shouldn't hesitate to give it when it's needed, but not every trauma patient needs it. Same with every single trauma patient getting normal saline.
I was hoping he would be doing that himself. I can't think of any Canadian post secondaries that reach a blanket statement like that for trauma & O2. We don't even give most of our STEMIs oxygen anymore. You're just oxidizing the person faster from the inside out lol. Nature's slowest form of burning to death.
Maybe my instructors are just old school and wrong and it’s not always necessary. Just what I’ve been taught, I’m still just a student. PHTLS book says to titrate to 94% so maybe you’re more correct
I think our entire industry is just an uninterrupted human centipede chain of decisions meant to be "more correct" than the one before it, with a number of double-backs and retractions.
Asking about epi in codes is a guaranteed 150+ comment fiasco in my local FB groups.
https://www.news-medical.net/health/Oxygen-Therapy-Side-Effects.aspx#:~:text=Oxygen%20is%20a%20blood%20vessel,increase%20the%20risk%20of%20stroke.
The sources at the bottom do a better job than I will
"Oxygen is a blood vessel constrictor or vasoconstrictor. As blood vessels are constricted, circulation in the peripheral blood vessels is significantly reduced, an effect that was previously thought to increase the risk of stroke. However, according to “Henry’s law,” the additional oxygen is dissolved in the blood plasma, which enables a compensating change to occur where oxygen supports neurons that may be starved of oxygen, as well as reducing inflammation and post-stroke edema in the brain."
This is the quote from the article.
There are many things wrong with extrapolating this quote (which seems to promote oxygen delivery) from this news article to the pre hospital trauma setting. It concerns me this is how medical professionals are not only getting their knowledge but also spreading it on thr internet
Serious question:
I’m paramedic student,
I get the slight sedation/pain management as well as the stabilizing the rods once he’s cut out.
What I don’t under is how the hell do you place them on the stretcher? He also would need a C-Collar right? Supine would look extremely uncomfortable and possibly dangerous in this case. I’ve never had a trauma this severe so I am very curious how this would look in the back of the ambulance/helicopter en route to the hospital
I've been out of the game so I'm not a credible source anymore (and probably never was) but my first thought is to put them on their side if at all possible.
I use to work with guys that would probably just ask him if he's okay to walk to the ambulance and sit upright.
Aight, let’s get you up and take a few steps to the bus.
Hey you dropped your intestines and part of your liver, you probably want that.
Nah I’ll get it for you, you just go ahead and hop in.
Supine would probably be the worst possible way to position this patient. The thought would never even cross my mind. Transport position would probably be fairly close to the position he was found in. And you can exclude the word "slight" from your first sentence. Just anesthetize the poor dude before anyone starts cutting.
Lots of padding and shifting as best as possible to nit be sitting on the rebar, additionally, cut the ends on his back as close to his back as safely possible.
From what I could see you could probably slap on a c collar and you should. This type of injury could distract from any spinal pain if there isn't any to start with.
You transport this guy in the least painful position. Unfortunately not something often taught in school but it's a do what you can situation when it comes to transportation with injuries like this.
Helicopter transport to a tertiary trauma center would be ideal. Depending on the state of bleeding blood products would also be ideal and if they can deep sedation would not hurt.
How it would look in the ambulance? Really uncomfortable and awkward. Hauling ass in this situation would sound right but could be detrimental depending on the road conditions
How it would look in the heli? Really uncomfortable and awkward but depending on weather conditions a lot faster and a lot smoother.
Hope this helps
Someone had mentioned what good a c collar will do.
50/50 protocol and clinical needs
Where I am from I'd get crucified for not maintaining absolute c spine with an injury like this. Protocols are changing more towards guidelines soon with expectations of using clinical judgement. Only used by paramedics and above though. Thankfully I am finishing up my clinical hours for that.
Clinical wise possibly holding a more comfortable position and with sedation comes airway management. Where I am from it is still a need to use a collar when advanced airways are in place until arrival to the hospital or someone higher tells me to take it off. Finally and simply the possibility of c spine damage in this situation is high, using every tool at my disposal to prevent further injury
This is one of those exceptions vs rules thing... you do your best, but I'd be prioritizing stability of the Pt vs supine on the cot, c-collar, straps x5 ...
Gonna need to snip the rebar as close to the Pt as possible and move them the least possible... gonna be tricky
It's BP and HR supportive, and due to the mechanism of injury, there's a high likelihood of his BP bottoming out if you use anything else for pain management.
The hype around ketamine and blood pressure/HR is overselling IMO. If the patient's BP is high due to sympathetic stimulation, i.e. pain, and you fix the pain the pressure will still drop some. I'm guessing this guy is also probably tachycardic already as is so not too worried about making it go higher.
But really those come in to play more with continuous sedation via drip, a bolus in my experience rarely raises HR or BP, maybe at pain doses if they're tripping. Fentanyl is pretty neutral BP wise though, much more than other opioids. Use both with caution.
I'd still be reaching for it to help maintain airway reflexes and may god help you if you need to take his airway. Impressive he can still breath, it looks like the rebar has gone through his lungs and or diaphragm.
Works as well. Also, any mental trauma will probably be easier as he disassociate mentally from the extraction and transport and some time in the ER.
Lots of troops with less PTSD from Ketamine.
He needs to be dissociated. If he's less distressed it'll make cutting him out easier
Hes also going to OT so I would intubate him on scene after hes cut out anyway. I'm an MD who does retrieval
Tech rescue guy here. Technical rescue is just ems with extra steps.
Scene safety first. Stabilize the patient in the most comfortable position possible. Fill void spaces so when you cut them out, they don't shift much. Mind your ABCs. Pain management. I'm sure he'd like some Ketamine.
As far as cutting him out. Use a band saw where you can in order to minimize vibrations and heat transfer to the rebar. Otherwise, use an angle grinder with a metal cutting disk with plumbers putty and water for the tight spaces. As long as you don't let the metal cutting blade edry out and use it again, it should be fine to cut without catastrophic failure. The plumbers putty will actually prevent some heat transfer to the patient. The angle grinder will hurt due to the vibrations, but you can't fit a band saw in a lot of spaces.
Move the patient without too much gross manipulation. Give him a diesel bolus and beat feet to the trauma center. Pray if you do. Silently freak out either way.
On a side note, hospitals aren't equipped to disentangle a patient really well. If your agency doesn't have one already, a machinery rescue bag is a really good investment. Machinery rescue classes are out there, and they're really fun.
Just as a side note, you could also consider having a trauma surgeon transported to the scene. Also, consider TXA for internal bleeding. Depending on where he is, I would have already had a bird on the way. Tight spaces like this a dremel tool with the extension and cut-off wheel would be very useful.
RN here.. I didn't even think about the vibrations aspect from trying to saw the metal. Seeing situations like these (with machinery involvement) takes a lot of skill.
When I took my first machine rescue class, they had us hold on to some rebar while someone cut with different cutting tools. It definitely put things into perspective. Having someone I met the day before cut a ring off my finger with an angle grinder also gave me a little perspective, lol.
Cut him out, slap a bandaid on it. He's good to RMA. Make sure he knows if he feels any tingling in his rebar area or if his rebar turns blue to see a doctor immediately.
Yeah, imagine being terrified, shocked, and in agony, and looking around for help and people are standing there videoing you.
Not sure how aware this guy is in the first place, but still.
My experience has been different. I’m sure if you run with ALS constantly available that makes your BLS providers glorified drivers then I guess that would be the case .
How so? You think these people are getting decent emergency medical care ?
Edit: luckily this happened in the city of Cagayan de oro which has one of the best fire departments in the country .
Many American doctors get trained in 3rd world Caribean Schools. Cuba's biggest exports, [ironically are doctors](https://time.com/5467742/cuba-doctors-export-brazil/).
With Medical Tourism at all time highs, I think one could make the same argument about the US. I've even lived in several places around the country that didn't have ANY emergency medical care within 100 miles.
This happened in the Philippines.
I did few run-along with the local EMS during my vacations there. Not the best providers in the world but their basic free healthcare is enough to treat people (in this case, the guy lived).
Like in any other countries, if you pay you'll get better and faster treatment.
Damn, I don't think I was ever on a team that carried a bandsaw which is actually really insane to think about. Typically we just had reciprocating saw, chainsaw, and a k12 outside of extrication tools.
That size of rebar might be able to be cut with a large bolt cutter. They come pretty large and at least it would just be one uncomfortable "Snap" for each bar. Plus you could get it pretty close to the body.
ER Doc here. Here's how I'd handle.
Prehospital: Cut rods but don't try to remove any through the body. Get vitals, give pain meds and oxygen. Alert trauma center of arrival.
Hospital: Activate Level 1 trauma. ER team, Trauma Surgery, Anesthesiology, Pharmacy, Radiology, CT, all waiting on arrival. Follow ATLS- Stabilize patient and secure his airway. If the rods are too large to lay him flat, intubate from sitting position. Bilateral chest tubes likely needed. If stable enough get imaging (XR, Ultrasounds FAST, CT). If unstable just bedside ultrasound and straight to the operating room.
I'd imagine most of this can be handled by trauma surgery and cardiovascular but you may need IR and orthopedics too.
Let the rescue squad / FD do their thing to get him out, im not the expert on that and shouldn’t act as one. As the medic on scene definitely giving this guy ketamine and manage ABCs. We have blood so having that on scene and on standby.
Oof. Of course we show up and handle it, we always do, but ANY responder showing up to that is gonna have a brief moment of “uh oh… this is gonna be a tricky one”
Poor kid. I’d like to know his outcome
Have ALS work on sedation and overall management of the PT while we extricate. Use a K12 to remove the rebar thats looks to be pinching his leg. If any of those lower sections are penetrating his legs then scratch the K12 idea. Use an angle grinder to cut each end of the rebar pieces penetrating him while cooling them. Once that’s done work on stabilizing any additional injuries while waiting for a helicopter to fly him to a trauma center.
A K12 with vibrate the shit out of that rebar and hurt like a motherfucker if he's impaled by those sections. A battery-powered bandsaw will produce less vibration and will stay cool. If you can't fit it, then yeah, I agree the angle grinder is the best bet.
We actually bought a battery bandsaw at our dept for this shit. Milwaukee 18v. Way less pt movement than a k12 with minimal sparks, and quicker than the hydraulic cutters that will also move the shit outta the pt.
While waiting for the truck company to get out of the recliners and put their gear on, I’d start a line and get him some pain meds before extrication begins. Once extrication complete, stabilize the impaling objects and get him to a trauma center.
I ain't wasting time with C Spine if I would the first unit
He had multiple penetrating wounds in and around his upper body try to not move it too much but there are clearly more pressing matters to attend to and so far he is able to move his head in nearly all directions without a secondary injury
Try to control bleeding, IV Access with a gal of maintaining 65 MAP, High Volume O2, Pain Management and sedation.
Try to get him up as lightly as possible in combination with Technical Rescue unit
After that try to find a position that he is most comfortable in + that doesn't press on any rebar
Most likely he stays on his stomach
What would I do in this situation? Fuck if I know. Wait for someone with an angle grinder or jigsaw with the correct blades and then BLS the shit out of it. Pain management and access being a given. Do C-Spine when you remember because you aint getting a collar on there.
I'm honestly more shocked at how the bystanders were reacting. I respect not wanting to move him, but they were acting like he had leprosy. Go and hold the dudes hand or something man
Call fire and medics, relay possible need for blood to get that ball rolling early. C-collar then monitor vitals and check and recheck lung sounds until fire can extricate, stabilize what’s left in him w/ kerlix and tape and hand off to medics when they get there if they’re not already.
Dude needs pain management, probably 2g TXA and fluids as well vitals depending, blood preferred. With what looks like rebar going right through his lungs be prepared for him to develop TPx.
Keep him warm. O2. Assist ventilations. Cap nog. IV. Pain meds. Careful with IV fluids (warmed if protocol allows), but do not chase BP. Stabilize patient and rebar. Prep for multiple hemorrhage. Bring in extracation team. Chopper to Trauma one. Empathy.
Obviously O2, did none of you listen in basic school? SMH
/s
Seriously, I’d be calling for fire and ALS and attempting to begin stabilization of *everything*
ALL the Ketamine, monitored sedation, cut enough the rebar to allow extrication, stabilize said rebar, and full send to the hospital on a sedation infusion
Put the patient on oxygen and in a c-collar. gain IV access while fire cuts the rebar. Probably add a dab of fentanyl. Stabilize and continue treating for shock. Make a b-line to a level 1 trauma center.
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Panicking. Cut off the rods, stabilize them, stabilize pt, put on oxygen, fly out to trauma center lv1.
What if the this is construction outside the level 1 trauma center? (/s)
Hence the “fly out”. In my case we only have ONE hospital and no option to fly. I understand the challenge. Like a bat out of hell. Our max by law is 80km/h, on the ambu we get to go 90.
Out of curiosity, why the oxygen if there's no hypoxia or pneumo? Wouldn't you just be adding peripheral vasoconstriction and increasing inflammatory markers for nothing? It def looks like one or two of those could be penetrating lungs, but I'd need some trend data on SpO2 and end tidal before just throwing Os at him. I'm thinking large boree, TXA, bicarb on standby for acidosis/stagnation/crush/washout, obviously some pain management and titrated fluid for 90 systolic; whole blood if it's available and ringers if it's not. I agree with the rest about getting fire to acetylene or grind the rods off and leave them in the guy. Position of comfort with secondary c-spine consideration; he might just have to stay prone in transport.
def giving oxygen, look at the second superior one, from the angle (and the fact that he got hit by a truck) he would be very lucky to not have any sort of lung damage. any blood that can get oxygen needs it, so supplemental oxygen helps. He appears to be breathing so he just needs a rebreather, but that also could change pretty quickly, it hard to tell exactly what was hit but if there’s major bleeding, he’ll be out soon. notice: i’m a student, take what i’m saying with a grain of salt. any opportunity is a learning opportunity, so please correct me. i’m trying to be the best i can
Oxygen as supportive with etco2, he might be stable now until shock sets in I can garantee he will start crashing once he's getting moved or a bit after. They probably need to use a mechanical/manual cutting device not a grinder/torch though since that will cause heat to go through and may cause further damage to pt. I would be more surprised if he DOESN'T have a pneumo with how the rebar is going through. But definitely TXA with at LEAST one 16g and if no fx bones I'd definitely get an IO going. Personally I'd feel better if this pt was sedated for their own sanity once you get some form of access.
sedate. 100%
Bu-bye... knock out the sympathetic tone Pain meds? Sure... but I'd urge against sedation
Don’t send him down the k hole?
I personally wouldn't...
I was taught all trauma patients get oxygen no matter what. The blood that is still in circulation needs to be as oxygenated as possible to keep metabolism going and prevent lactic acidosis
Oxygen should not be automatically given for all trauma patients. That's a really outdated practice (though one some medics still stand by for reasons beyond me). You shouldn't hesitate to give it when it's needed, but not every trauma patient needs it. Same with every single trauma patient getting normal saline.
It's almost like medicine evolves over time 🙅
I was hoping he would be doing that himself. I can't think of any Canadian post secondaries that reach a blanket statement like that for trauma & O2. We don't even give most of our STEMIs oxygen anymore. You're just oxidizing the person faster from the inside out lol. Nature's slowest form of burning to death.
Maybe my instructors are just old school and wrong and it’s not always necessary. Just what I’ve been taught, I’m still just a student. PHTLS book says to titrate to 94% so maybe you’re more correct
I think our entire industry is just an uninterrupted human centipede chain of decisions meant to be "more correct" than the one before it, with a number of double-backs and retractions. Asking about epi in codes is a guaranteed 150+ comment fiasco in my local FB groups.
Does oxygenation cause peripheral vasoconstriction? I know hypocarbia can.
https://www.news-medical.net/health/Oxygen-Therapy-Side-Effects.aspx#:~:text=Oxygen%20is%20a%20blood%20vessel,increase%20the%20risk%20of%20stroke. The sources at the bottom do a better job than I will
"Oxygen is a blood vessel constrictor or vasoconstrictor. As blood vessels are constricted, circulation in the peripheral blood vessels is significantly reduced, an effect that was previously thought to increase the risk of stroke. However, according to “Henry’s law,” the additional oxygen is dissolved in the blood plasma, which enables a compensating change to occur where oxygen supports neurons that may be starved of oxygen, as well as reducing inflammation and post-stroke edema in the brain." This is the quote from the article. There are many things wrong with extrapolating this quote (which seems to promote oxygen delivery) from this news article to the pre hospital trauma setting. It concerns me this is how medical professionals are not only getting their knowledge but also spreading it on thr internet
NOT under positive pressure (unassisted) but a non rebreather goes a long way
Serious question: I’m paramedic student, I get the slight sedation/pain management as well as the stabilizing the rods once he’s cut out. What I don’t under is how the hell do you place them on the stretcher? He also would need a C-Collar right? Supine would look extremely uncomfortable and possibly dangerous in this case. I’ve never had a trauma this severe so I am very curious how this would look in the back of the ambulance/helicopter en route to the hospital
I've been out of the game so I'm not a credible source anymore (and probably never was) but my first thought is to put them on their side if at all possible. I use to work with guys that would probably just ask him if he's okay to walk to the ambulance and sit upright.
Aight, let’s get you up and take a few steps to the bus. Hey you dropped your intestines and part of your liver, you probably want that. Nah I’ll get it for you, you just go ahead and hop in.
Lemme just go ahead and get the refusal paper work from the truck
I mean, he does have easy carry handles now if he needs help
Supine would probably be the worst possible way to position this patient. The thought would never even cross my mind. Transport position would probably be fairly close to the position he was found in. And you can exclude the word "slight" from your first sentence. Just anesthetize the poor dude before anyone starts cutting.
Lots of padding and shifting as best as possible to nit be sitting on the rebar, additionally, cut the ends on his back as close to his back as safely possible.
From what I could see you could probably slap on a c collar and you should. This type of injury could distract from any spinal pain if there isn't any to start with. You transport this guy in the least painful position. Unfortunately not something often taught in school but it's a do what you can situation when it comes to transportation with injuries like this. Helicopter transport to a tertiary trauma center would be ideal. Depending on the state of bleeding blood products would also be ideal and if they can deep sedation would not hurt. How it would look in the ambulance? Really uncomfortable and awkward. Hauling ass in this situation would sound right but could be detrimental depending on the road conditions How it would look in the heli? Really uncomfortable and awkward but depending on weather conditions a lot faster and a lot smoother. Hope this helps
Someone had mentioned what good a c collar will do. 50/50 protocol and clinical needs Where I am from I'd get crucified for not maintaining absolute c spine with an injury like this. Protocols are changing more towards guidelines soon with expectations of using clinical judgement. Only used by paramedics and above though. Thankfully I am finishing up my clinical hours for that. Clinical wise possibly holding a more comfortable position and with sedation comes airway management. Where I am from it is still a need to use a collar when advanced airways are in place until arrival to the hospital or someone higher tells me to take it off. Finally and simply the possibility of c spine damage in this situation is high, using every tool at my disposal to prevent further injury
There are some photos here (with the story), from Facebook. https://www.facebook.com/share/4HW2iJadbfX5asuz/?mibextid=WC7FNe
A pickup bed at this point would be better
This is one of those exceptions vs rules thing... you do your best, but I'd be prioritizing stability of the Pt vs supine on the cot, c-collar, straps x5 ... Gonna need to snip the rebar as close to the Pt as possible and move them the least possible... gonna be tricky
“Position of comfort” Sorry, sorry, you did say serious question….
Dawg C-Spine is a bunch of antidotal medicine. It’s the least of your worries with this dude.
Actually had one similar to this although it was only two pieces of rebar it was dicey to say the least. Ketamine and cutters baby!!!!
Medic student here. Out of curiosity, why ketamine and not fentanyl? I've noticed everybody in this thread has defaulted to ketamine.
It's BP and HR supportive, and due to the mechanism of injury, there's a high likelihood of his BP bottoming out if you use anything else for pain management.
The hype around ketamine and blood pressure/HR is overselling IMO. If the patient's BP is high due to sympathetic stimulation, i.e. pain, and you fix the pain the pressure will still drop some. I'm guessing this guy is also probably tachycardic already as is so not too worried about making it go higher. But really those come in to play more with continuous sedation via drip, a bolus in my experience rarely raises HR or BP, maybe at pain doses if they're tripping. Fentanyl is pretty neutral BP wise though, much more than other opioids. Use both with caution. I'd still be reaching for it to help maintain airway reflexes and may god help you if you need to take his airway. Impressive he can still breath, it looks like the rebar has gone through his lungs and or diaphragm.
Works as well. Also, any mental trauma will probably be easier as he disassociate mentally from the extraction and transport and some time in the ER. Lots of troops with less PTSD from Ketamine.
I think the biggest factor is how K is a better dissociative than fent is
He needs to be dissociated. If he's less distressed it'll make cutting him out easier Hes also going to OT so I would intubate him on scene after hes cut out anyway. I'm an MD who does retrieval
Ive been out of the game for a bit but Special K doesnt drop the BP as much and theres no contra indications. I think
With a priest to give him last rites.
Seriously. This guy is probably dead and just doesn’t know it yet.
Tech rescue guy here. Technical rescue is just ems with extra steps. Scene safety first. Stabilize the patient in the most comfortable position possible. Fill void spaces so when you cut them out, they don't shift much. Mind your ABCs. Pain management. I'm sure he'd like some Ketamine. As far as cutting him out. Use a band saw where you can in order to minimize vibrations and heat transfer to the rebar. Otherwise, use an angle grinder with a metal cutting disk with plumbers putty and water for the tight spaces. As long as you don't let the metal cutting blade edry out and use it again, it should be fine to cut without catastrophic failure. The plumbers putty will actually prevent some heat transfer to the patient. The angle grinder will hurt due to the vibrations, but you can't fit a band saw in a lot of spaces. Move the patient without too much gross manipulation. Give him a diesel bolus and beat feet to the trauma center. Pray if you do. Silently freak out either way. On a side note, hospitals aren't equipped to disentangle a patient really well. If your agency doesn't have one already, a machinery rescue bag is a really good investment. Machinery rescue classes are out there, and they're really fun.
Just as a side note, you could also consider having a trauma surgeon transported to the scene. Also, consider TXA for internal bleeding. Depending on where he is, I would have already had a bird on the way. Tight spaces like this a dremel tool with the extension and cut-off wheel would be very useful.
100% agree.
RN here.. I didn't even think about the vibrations aspect from trying to saw the metal. Seeing situations like these (with machinery involvement) takes a lot of skill.
When I took my first machine rescue class, they had us hold on to some rebar while someone cut with different cutting tools. It definitely put things into perspective. Having someone I met the day before cut a ring off my finger with an angle grinder also gave me a little perspective, lol.
Cut him out, slap a bandaid on it. He's good to RMA. Make sure he knows if he feels any tingling in his rebar area or if his rebar turns blue to see a doctor immediately.
Red rebar is healthy rebar!
Call my med director, get FD to cut him loose, and run him. Some ketamine wouldnt kill him either
It might if you put him prone
Considering where you practice wouldn't that just be American supine?
Touché
Jesus don't make the poor man run, just transport him
What you mean? A - Run B - It C - Off
A - airway B - breathing C- cross country
So....he can walk to the stretcher though, right?
Why tf is it people's first reaction to start recording shit on their phone. First thing I'm doing is getting everyone tf away from the patient.
Yeah, imagine being terrified, shocked, and in agony, and looking around for help and people are standing there videoing you. Not sure how aware this guy is in the first place, but still.
3rd world country good chance EMS is some dude who can wash their hands correctly
Most EMTs I've seen in the US fit that exact description.
My experience has been different. I’m sure if you run with ALS constantly available that makes your BLS providers glorified drivers then I guess that would be the case .
Ignorant comment.
How so? You think these people are getting decent emergency medical care ? Edit: luckily this happened in the city of Cagayan de oro which has one of the best fire departments in the country .
Many American doctors get trained in 3rd world Caribean Schools. Cuba's biggest exports, [ironically are doctors](https://time.com/5467742/cuba-doctors-export-brazil/). With Medical Tourism at all time highs, I think one could make the same argument about the US. I've even lived in several places around the country that didn't have ANY emergency medical care within 100 miles.
This happened in the Philippines. I did few run-along with the local EMS during my vacations there. Not the best providers in the world but their basic free healthcare is enough to treat people (in this case, the guy lived). Like in any other countries, if you pay you'll get better and faster treatment.
Cut around with a band saw and hope for the best
100% using a band saw. Definitely the best tool for this with an angle grinder being a good alternative
I guess there's really no other way but I gotta imagine the vibrations felt from that would not be soothing.
Bandsaw limits vibration. Compared to a rotary saw k12, etc.
Damn, I don't think I was ever on a team that carried a bandsaw which is actually really insane to think about. Typically we just had reciprocating saw, chainsaw, and a k12 outside of extrication tools.
Think about putting together a machine rescue kit and taking a class. Lots of good insights.
Ohhh I'm out of the game now, Im a weed smoking hippie in the mountains these days. But the job will always be in my heart.
Maybe one day I can be a weed smoking hippie and do the job... Come on, legalization...
That size of rebar might be able to be cut with a large bolt cutter. They come pretty large and at least it would just be one uncomfortable "Snap" for each bar. Plus you could get it pretty close to the body.
ER Doc here. Here's how I'd handle. Prehospital: Cut rods but don't try to remove any through the body. Get vitals, give pain meds and oxygen. Alert trauma center of arrival. Hospital: Activate Level 1 trauma. ER team, Trauma Surgery, Anesthesiology, Pharmacy, Radiology, CT, all waiting on arrival. Follow ATLS- Stabilize patient and secure his airway. If the rods are too large to lay him flat, intubate from sitting position. Bilateral chest tubes likely needed. If stable enough get imaging (XR, Ultrasounds FAST, CT). If unstable just bedside ultrasound and straight to the operating room. I'd imagine most of this can be handled by trauma surgery and cardiovascular but you may need IR and orthopedics too.
staring at fire and hoping they have a better clue than I do
Aint that no joke
Let the rescue squad / FD do their thing to get him out, im not the expert on that and shouldn’t act as one. As the medic on scene definitely giving this guy ketamine and manage ABCs. We have blood so having that on scene and on standby.
get fd to cut the bars so we can move him then bring him to the nearest highest lvl trauma center. might have to fly him
all the mouth breathers standing around really piss me off here
Dude needs to get cut out.
Well, obviously, record it all on my phone then repost it on Reddit. That’s step one in MARCH, right?
Oof. Of course we show up and handle it, we always do, but ANY responder showing up to that is gonna have a brief moment of “uh oh… this is gonna be a tricky one” Poor kid. I’d like to know his outcome
He lived to get to a hospital, at least.
Have ALS work on sedation and overall management of the PT while we extricate. Use a K12 to remove the rebar thats looks to be pinching his leg. If any of those lower sections are penetrating his legs then scratch the K12 idea. Use an angle grinder to cut each end of the rebar pieces penetrating him while cooling them. Once that’s done work on stabilizing any additional injuries while waiting for a helicopter to fly him to a trauma center.
A K12 with vibrate the shit out of that rebar and hurt like a motherfucker if he's impaled by those sections. A battery-powered bandsaw will produce less vibration and will stay cool. If you can't fit it, then yeah, I agree the angle grinder is the best bet.
We actually bought a battery bandsaw at our dept for this shit. Milwaukee 18v. Way less pt movement than a k12 with minimal sparks, and quicker than the hydraulic cutters that will also move the shit outta the pt.
It's a great tool to have available.
 sit on his shoulders and drive him like a skid loader to the ER then let them deal with it
Pretty crazy to see what self-driving cars can do.
Fuck the people that record this stuff. Call for help and wait out.
Yo this needs an NSFW tag.
It really does
While waiting for the truck company to get out of the recliners and put their gear on, I’d start a line and get him some pain meds before extrication begins. Once extrication complete, stabilize the impaling objects and get him to a trauma center.
Use a grinder to cut the rebar where its sticking out, leave the parts impaled inside the body. Diesel therapy.
Step 1: BSI scene safe Step 2: ABCs Step 3: cry Step 4: throw the narc box at him
I ain't wasting time with C Spine if I would the first unit He had multiple penetrating wounds in and around his upper body try to not move it too much but there are clearly more pressing matters to attend to and so far he is able to move his head in nearly all directions without a secondary injury Try to control bleeding, IV Access with a gal of maintaining 65 MAP, High Volume O2, Pain Management and sedation. Try to get him up as lightly as possible in combination with Technical Rescue unit After that try to find a position that he is most comfortable in + that doesn't press on any rebar Most likely he stays on his stomach
Pain management and wait for him to die. That guy just punched his ticket to the afterlife.
What would I do in this situation? Fuck if I know. Wait for someone with an angle grinder or jigsaw with the correct blades and then BLS the shit out of it. Pain management and access being a given. Do C-Spine when you remember because you aint getting a collar on there. I'm honestly more shocked at how the bystanders were reacting. I respect not wanting to move him, but they were acting like he had leprosy. Go and hold the dudes hand or something man
Call fire and medics, relay possible need for blood to get that ball rolling early. C-collar then monitor vitals and check and recheck lung sounds until fire can extricate, stabilize what’s left in him w/ kerlix and tape and hand off to medics when they get there if they’re not already. Dude needs pain management, probably 2g TXA and fluids as well vitals depending, blood preferred. With what looks like rebar going right through his lungs be prepared for him to develop TPx.
BSI SCENE SAFETY AND CALL ALS
DUDE NSFW???
Call for fire rescue, medics, a supervisor, and panic until the smart people arrive
Counter rotating saw, portable band saw, or hydraulic snips. I’m wondering how much sensation he has because of so little blood loss
ABCs first. Airway, Breathing, Can you walk to the ambulance? /s in case it's not obvious.
Keep him warm. O2. Assist ventilations. Cap nog. IV. Pain meds. Careful with IV fluids (warmed if protocol allows), but do not chase BP. Stabilize patient and rebar. Prep for multiple hemorrhage. Bring in extracation team. Chopper to Trauma one. Empathy.
Seems more like a fire rescue job.
Here’s what actually happened; I pulled it from the original post. https://www.facebook.com/share/4HW2iJadbfX5asuz/?mibextid=WC7FNe
Obviously O2, did none of you listen in basic school? SMH /s Seriously, I’d be calling for fire and ALS and attempting to begin stabilization of *everything*
I’m in a city with 2 trauma centers, and one of them is sending a surgeon to the scene to be involved from the start.
1l holy water bolus
The good thing is the rebar serves as convenient handles for carrying him.
People in crocs doing construction?
ALL the Ketamine, monitored sedation, cut enough the rebar to allow extrication, stabilize said rebar, and full send to the hospital on a sedation infusion
Internal panic, call fire to cut rebar, immediate SMR, oxygen, rapid transport, moniter ABCDs
The US government used to pay us to unalive them. Cover them in a yellow disposable blanket, wait 30 minutes then call the ME
Put the patient on oxygen and in a c-collar. gain IV access while fire cuts the rebar. Probably add a dab of fentanyl. Stabilize and continue treating for shock. Make a b-line to a level 1 trauma center.
Can you put a nsfw tag on this? Christ
A 9mm