In an exciting kick off to the highly anticipated Trauma Week 2022, my Fundamentals in Biomedical Sciences (II) Class , was visited by various members of the Mobile Fire Rescue Department, physicians from University of South Alabama’s (USA) Medical School, and some staff members from the USA Emergency Room at Hillcrest. The day began with a demonstration of injury, portrayed by a few Biomed students. We watched as a student was “injured” on the football field during a “pileup”. The student was assessed by an Athletic Trainer (our very own Mr. Bentley), who determined that the injury was too severe for his care alone. He called over Dr. Rippy, a physician for the University of South Alabama, to further assess the athlete. The athlete was in severe pain, with an open wound that presented as a Tib-Fib fracture of the left leg. The EMS team was called over to the scene, as it was determined that the injury required immediate transport to the Emergency Room for treatment. The athlete was placed onto a stretcher before being loaded into an Ambulance and transported to the Emergency Room.
We then traveled to the auditorium, which would serve as the Emergency Room for the day's presentations. Before “receiving our patient”, Dr. Rippy, a physician for the University of South Alabama, spoke with us briefly about on field care. He discussed how he is constantly observing the behavior of the athletes. This includes watching who lingers on the ground a little too long after a tackle and even who may accidentally go to the wrong sideline after a play! Dr. Rippy notes that when he is at a football game, he never even watches the ball because he is focused on the athletes. While treating a patient on the field, physicians, trainers, EMTs, or other emergency service/healthcare personnel have to be able to control not only their patient, but those around them. This includes fans, parents, players, and referees who may interfere with the care of the patient. The physical appearance of these people are actually very important to crowd control as well. The health care professionals cannot seem timid, panicked, or overwhelmed, for it will make bystanders lose trust. The health care professionals must maintain a calm and composed manner that appears relaxed while still recognizing the urgency of the situation.
While on the ambulance headed towards the Emergency Room, the Firemedics collect a history of the patient. For our patient in particular, it was determined that he, a 17 year old male, had no allergies, was on no medications, nor had a pertinent past medical history. His mechanism of injury (MOI) was a tackle from an opposing team member. While in route, our patient was placed in a Sam Splint and given morphine for pain. He maintained a pedal pulse, indicating blood flow to his foot. His vital signs were taken and are as follows: BP: 125/84, 95 Pulse, Respiration 16. There were no changes to his state in route; he remained stable and responsive for the entire trip. The firemedics alerted the ER of the patient they were bringing their way so that the ER staff would be prepared as soon as the ambulance reached the trauma bay.
When the patient entered our “ER”, we were met by Keri Bryant (BSN, TCRN, CEN), an Emergency Room nurse from the USA ER at Hillcrest. She spoke to us about the care the patient might receive in an ER setting. She discussed that the nurses would give a full assessment of the patient to check for any injury to another part of the body. The tib-fib fracture (Tibia, Fibula), the injury later determined, causes so much pain that it may distract from other injuries, such as those to the spinal cord. The “path” in which a patient of this caliber would follow with an ER nurse would typically look something like this: Receive Patient, Stabilize Patient, Send to Radiology, Return to ED, Continued Care. The amount/type of healthcare personnel who see a patient are dependent upon various factors. These factors include availability of personnel as well as severity of injury. Traumas at USA ER are categorized as “level one” or “level two” traumas. Level one traumas involve severe injury to multiple parts of the body while level two traumas are those involving a singular injury. The “level” of injury dictates which team of nurses/physicians/physicians assistants will be treating the patient.
After thorough examination of the patient, it was determined by the healthcare professionals that his injury was limited only to his left leg, where the fracture occurred. Since our patient had an open fracture, his wound was cleaned thoroughly multiple times and various antibiotics were administered including penicillin. Our patient was in extreme pain, so the splint placed by EMS was removed and replaced with a Hare Traction Splint. This splint stretches the leg, relieving pressure (which assists in pain relief) and more adequately aligning the break. Nurse Bryant ended her presentation with a list of some possible complications that could occur with such an injury. These include, but are not limited to, Compartment Syndrome, Infection, Malunion (bone healing in abnormal position), and Blood Clots.
We then received a presentation from Greg Yeager who spoke with us about the different modalities of Radiology. With a simple fracture, a scan would be taken with a portable-ray machine, but with a patient of our caliber, the scan would be taken in an x-ray room. With any bone fracture, the radiographers would take at least two images of the patient’s injury, with the first most likely being the Anterior-Posterior (AP) View. We also discussed CT Scanning. CT Scanners use high amounts of radiation, but are incredibly quick scans that allow for 3D imaging of bones and arteries. An MRI Scanner is a much longer scan that takes around 45 minutes to complete. Though time-consuming, the MRI scanner uses no radiation, so it is not a risk for the patient in that manner. The MRI gives superior soft tissue imaging. Another type of scan that can be taken is the Angiogram, which is used to observe blood flow. The final type of scan that we discussed was a C-Arm Scanner, which is used during surgery. This scanner uses small amounts of continuous radiation that allows for surgeons to view the internal state of a patient in real time. Pulling information from Radiology as well as using in-person examinations as a guide, surgeons will determine a course of action for a patient, determining if/when the patient will need surgery and, if necessary, what type of surgery would be needed. Dr. Slauterbeck, chief of orthopedic surgery and professor at the University of South Alabama, came to briefly discuss his role in this process. We will receive more in depth information about surgery tomorrow!
The final speaker that came today was Mr. McCarron from the Mobile Fire-Rescue team. He explained that to work in his field, one must possess thick skin, quick wit, courage, and physical strength/stamina. He talked with us about how we may choose to have a career as a Firemedic, of course, but it is important to consider many options when pursuing a career path. He discussed with us how the Mobile Fire Department pays for 50% of the tuition for those employees pursuing a higher degree. He explained that if we are willing to work hard enough, we can work as a Firemedic for a few years, then move on to upper level careers, which he sees a lot of. He was very clear that he would rather have a good employee for 5 years rather than an OK employee for 30 years.
Today was an excellent kick-off to Trauma Week, and I am excited to see where this patient will end up. This week is particularly exciting for me, as the two fields that I am most fascinated by are Emergency Medicine and Orthopedics!
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