Posted by: medicblog999 | August 4, 2009

Thinking outside of the box!

thinking outside the box

Ive just been reading a post over at ‘life under the lights’ where CK writes about a job where he really had to think laterally about how to manage his patient. Click here to go and have a read, its a really interesting post!

It got me to thinking though. I firmly believe that some of the most important lessons I have learned since I joined the service in 2000, have come from experienced paramedics and advanced technicians who have come up with really good ideas for some really difficult situations.

One that springs straight to mind is a job I went to as a relatively new advanced technician.

Simon and I were called to a house for a 8 month old child who had rolled off the top bunk of a set of bunk beds and had landed head first onto a wooden floor. There was an apparent initial loss of consciousness, but when we arrived baby was screaming its little head off.

Going back  to training school and looking at the mechanism of injury, the kinematics involved in the fall, and the anatomical differences of a baby from an adult, the textbooks would tell you to collar and board the baby due to the risk of spinal injury. However, as we all know this is a virtual impossibility with a conscious baby and would probably  increase the risk of damage and injury from the baby struggling against the restraints.

Another conventional way to handle it is to get mum to immobilise the child in the ‘best possible way’ in her arms – hoping that once the baby settles, she will remain in a the neutral position that you have instructed mum to try and get her into.

Simon however came up with a different idea. One which I still use today if presented with a similar circumstance.

We carry full body vacuum splints which we sometimes use for major trauma/possible spinal injury/pelvic injury etc. It is more comfortable than the traditional spinal board and in the case of limb trauma along with spinal trauma, its a quick one fix, whole body immobilisation device. This would of course be HUGE for a little 8 month old baby girl.

Simon instructs me to go and get a leg vac splint.

IM734As I return to the patient with the splint and suction pump, I realise what he is going to do!

We lie the baby girl on the vac splint and gently shape it to her outline and hug it close to her head as we suck the air out of it making it go rigid. Because it is small enough to virtually be the same size as the baby, mum actually carries it on her whilst she lies on the stretcher which helps to keep baby placid during the journey.

As I came out of the A&E department once I had handed the baby over to the waiting team, all I could say to Simon was:

“What a Fab idea!!, that worked really well!”

What pearls of wisdom have been handed down to you over the years, to help in those rare situations when the ‘normal approach’ just doesnt work? Leave a comment and let us know. We all might learn something!

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Responses

  1. So far, I have learned how to rouse ‘unconscious’ patients that have had a few too many jars of ale using the pen on nail bed method. The pt that had been ‘unconscious’ to the police was soon wide awake upon paramedic intervention and so much so that the pt nearly head butted me on awakening.

    Other than that I’m far too soon into the job to be offering wisdom, but am sure that I’ll gleam a lot from this blog and various others.

  2. Having been immobilised both by being collard and boarded and in a vacuum splint I must say the vacuum splint was a lot more pleasant when your back/neck is already killing. Luckily I got out of both situations with a few pulled muscles and bruises. Freakily im writing a post about the same thing to post up soon.

  3. Thanks for the link Mark!

    The other shift we had an unresponsive, unknown who was *really* unresponsive and unknown. I couldn’t figure out exactly why he was unresponsive. Everything I checked was fine.. except for his unresponsiveness and hypothermia from laying on a cold hard floor for a couple of hours. I didn’t think that he was faking, due to his age and medical history.

    I told the EMT that I was with to “give him a PVC challenge”

    “Um, a what?” was his reply?

    “A PVC challenge. Put in a nasopharyngeal airway”

    I love those things. By rights, this guy could have been tubed, but he definitely had a gag reflex and he just didn’t meet my criteria for intubation even though he was “less than 8” on the GCS. He popped in a 28french naso airway and the Pt responded by yelling “Get this *(&$* outta my nose!!”

    PVC challenge. It works every time.

    That, and it’s a medical intervention.. not a cruel technique like some of the other responsiveness checks (like the pen thing) that are, well.. cruel

  4. That’s neat, Mark. I’ve seen pedi patients secured in Kendrick Extrication Devices (KED’s), but I might’ve never thought of a vacuum splint normally designed for an extremity.

  5. That’s brilliant! I’ve always gone with “stick them in their own child seat”, or at a push, KED as very few of our vans still carry vac splints, but hopefully when I move down south I’ll be back with them (but never have to put this concept into practice!)

  6. I’ve heard of that one – thought it was really clever too.

    Our favourite is to announce “ok they’re unconscious, get out the lube!” (for an NPA) on any drunks that are pretending to be unconscious. Gets the majority of them a little more lively in seconds!

  7. We had a pt with burns to the face & both hands who was not tolerating burngel. We eptied bottles of water into 2 vomit bags and stuck his hands in those for the trip to hospital. worked a treat

  8. And if you’re in the hospital, the Foley Challenge works wonders. As soon as the um, willie, is swabbed it’s amazing how many seizures stop and unconsciousness is reversed.

    Course, by then… it’s going in no matter what.


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