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11 Minutes in the Street - MVC Subject Pinned
You are first due at an Automobile Van verse Pedestrian accident with a subject reportedly "under the vehicle - unresponsive and breathing". Viewing the following picture from your apparatus officer's seat (windshield size-up) What are you going to do next?
What decisions are you going to make? How are you going to handle the good samaritan's willingness to extricate "YOUR" victim? Who are you going to call for assistance? Do you have a plan (if and WHEN) your tactical decision is not popular with these bystanders? or are you going to become another observer?
Tick tock, tick tock - time from the scene to OR is ticking...
Replies to This Discussion
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Permalink Reply by FETC on
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Compartment Syndrome - I expected to have Firefighter/Paramedics weigh in on this one.
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Permalink Reply by John Crabbe on
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The release of that much pressure on the body is too much shock. I'm not sure of exact details, and hopefully someone can fill in the many blanks for me, but I think it has something to do with the pooled blood in the body from flow being restricted, and the sudden release of pressure and getting the poisoned blood through the system.
Time is the issue there, the issue comes into play moreso in cases where a person is pinned for an extended time period. If this incident just occurred, then the worry about compartment syndrome is moot. Compartment syndrome concerns are more with a crush injury where the weight of the load remains on the patient for too long.
What I see here and what I'm guessing is this incident just occurred. Judging by the number of people trying to lift the vehicle, I'm guessing the person has not been entrapped too long. I concur with stabalizing the vehicle with cribbing and using airbags to raise the vehicle enought to get the pt out. The weight of the vehicle impacting the pt's ability to breathe is much more severe than the worry about compartment syndrome.
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Permalink Reply by Ben Waller on
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Not conventional...just looking at the photo.
Those Toyota vans have much more ground clearance to the bumper than to the front suspension, tie rod, and engine underpinnings. The bystanders may have lifted the bumper clear of the patient, but just barely. That tells me the patient is still likely pinned by some of the van's suspension parts, etc.
Also, you can't see one of the patient's legs. That leg could be anywhere - pinned beneath the left front tire and the pavement, for example.
I always err on the side of "trapped until proven otherwise". In my rescue company days, I can't count the number of times I was backing into quarters after being cancelled by the engine or medic, just to be recalled to the same scene ten minutes later because...OOPS...the patient really was trapped despite the underwhelming size-up by the first-arriving units.
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OK, I'm a firefighter-paramedic, so I'll weigh in.
Are you sure that you're talking about Compartment Syndrome and not Crush Syndrome?
Crush Syndrome is a reperfusion injury, also known as "The Smiling Death". This is the one where pinned patient who appear relatively stable crash and die within minutes after the pin is released.
Compartment Syndrome is a vascular obstruction injury caused by swelling from blood loss or tissue edema into a space surrounded by fascia, such as a skeletal muscle.
To confuse things a little more, Crush Injuries can cause either Crush Syndrome or Compartment Syndrome.
There is an excellent Power Point that explains both here.
Both generally require hours before the syndromes become critical, even the acute ones, but there are exceptions.
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John, what you described is Crush Syndrome. It is easy to get that mixed up with Compartment Syndrome. See my links below for good ways to tell the difference and how to treat both.
Crush Syndrome treatment starts with lots of IV fluids.
Compartment Syndrome requires a fasciotomy, generally in hospital.
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Permalink Reply by Derek R. on
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thanks Ben. That's a good read about lower extemity CS. Didn't see any mention on crush syndrome though. Maybe I missed something on the page. Now for some investigation into crush syndrome now that I have a name to go by.
thanks FETC. There's a lot of useful info in this thread.
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Did you look at the power point in my second link?
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if you mean the second link marked as "here"... then yes I did. But there was no power point.
This is where it takes me http://emedicine.medscape.com/article/1270542-overview
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Try this link for the Crush Syndrome vs Compartment Syndrome power point. It is contained in the .pdf document.
Sorry for the misdirect above.
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