Ep 44 Abdominal Trauma

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(39:41) This week we talk about abdominal trauma, shock and weight, and Ron’s last EMS shift of the semester. We also answer a number of listener questions.

Mentions:

An article on Assessing the Abdomen by Kelly.
The last episode where we talked about C-spine was Ep 41
Hartwell Vacum Mattress
CDC Field Triage Decision Scheme
EMSEducast Ep where CDC Triage was mentioned

Listener Questions

Jorge Romero
hey guys i got another question for you, this ones for kelly sorry ron lol. kelly what are your thoughts about emt-b and paramedic courses sought out in technical institutes and vocational schools rather than colleges and university.
Mike
Yes, I got another question. Sorry if I keep asking stupid questions, but I’m almost all the way through EMT-B class (3 weeks left, then the state practical, wait a month, month and a half, then the state computerized test. I was wondering, since I have friends who are EMTs now who are having trouble finding a private ambulance gig, how different is it to be an ER or in-hospital tech? I’m considering as another place to apply on top of the private ambulance services, but what exactly is a tech responsible for? The job listings I have currently found are rather vague in what exactly one does in this position. And I’m starting to seriously consider it as a job opportunity, instead of a backup to a private ambo gig.
Brandon Wehner – Fargo, ND
Anyways, while we were there, one of our crews asked the medic giving the tour about a call they had gone on. From what the crew said, they went on a rollover car accident where the car was down in a ditch, and they had to walk through about 4 feet of snow to get to the patient. They had taken c-spine and put a c-collar on the patient before the arrival of the ambulance. Once the medic got to the patient, he removed the collar and proceeded to clear c-spine. C-spine was clear and they walked the patient through the snow back to the road.

This incident got us talking at the station about your opinions on immobilizing the spine and how there is no evidence to support its use. Obviously we still backboard our patients because that’s what our protocols tell us to do, but we would like a refresher on how you think backboarding may harm a patient (which I know you’ve talked about before, but I can’t recall all the reasons), and if it would do harm to a patient, how would you move the person, assuming they for sure had a spinal injury.

I know this has been a long way to ask a question, so feel free to shorten it for the show. If you feel that you’ve covered this point a lot already and would rather not answer it again on the podcast, maybe you can point me to the show that it was in so we can listen to it there. Thanks for a great podcast.

Hey guys,
I was wondering if I could get your opinions on what you find more reliable when taking a blood pressure. I have been working as an EMT basic for about 5 years and have always been confident in my ability to get accurate b/p readings, but as I am progressing through paramedic school I am finding that when I auscultate a blood pressure my reading is consistently lower (although not much) than the reading I get from an auto cuff. As an example; I recently had a patient who’s auscultated blood pressure was 88/46 but the auto cuff reading was 99/50.
So I was curious what both of you thought was a more reliable method.
Thanks for your help
Aaron
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  • pyromedic

    If i may i would like to answer aaron’s question with something i was just told in my ccemt-p course that i did not know until i was told… the auto cuff does not actually obtain a blood pressure it obtains the MAP (mean arterial pressure) and the calculates what the systolic and diastolic should be based on the MAP. hope this helps.

  • Anonymous

    Thanks, that was one little nugget I had allowed myself to forget!

  • To add to the discussion about ER tech vs ambulance, it’s important to note that ER techs rarely work under their EMS license. So while things like IVs and foley caths might not be in the training, it isn’t outside the scope of an ER tech with an EMT license, given that the hospital has provided additional training.

    Another option to look out for, which isn’t at all hospitals, is ER scribe positions. The scribes in the ERs in my area are essentially direct assistants to the physician and do most of their documentation. That, of course, also means that they’re present during the exams, when the physician is interpreting labs, etc. While not technically a patient care position, according to friends of mine that have gone that route, the ER physicians have often unofficially involved their scribes in patient care.