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Originally Posted by JAGeorgia
Good guess. Been there. Basically everything was gone from the tip of the nose to the pharynx including approx 3/4 of mandible.
In swatsurgeon's case study and added caveats I would respond as follows:
I. Determine level of consciousness and proceed to II immediately. A. Conscious, determine ability to communicate/cooperate 1. Can communicate/cooperate
a. Reassess body position. Sitting position may be best to aide in draining blood/body fluids away from airway. On this point, position in pic is correct even in the field.
2. If uncooperative provide restraint as needed so airway and breathing do not become compromised.
a. Reassess body position. Prone, right or left side may be best to aide in draining blood/body fluids away from airway. Trendelenburg if danger of patient aspiration is minimal.
3. go to IV.
B. Unconscious 1. Reassess body position. Prone, right or left side may be best to aide in draining blood/body fluids away from airway. Trendelenburg if danger of aspiration is minimal.
2. go to IV.
II. Check airway. A. If airway is patent go to III. B. If airway not patent. 1. Position head/neck to establish an open airway
2. If 1 fails attempt to insert mechanical airway in this order of preference
a. oral airway
b. nasal airway
c. endotrachael intubation: personally, I'd go with nasal intubation, even if blind insertion but I have a ton of experience doing this. Not recommended for newbies.
d. crich/trach depending on skill and available resources. Remember these are invasive procedures and you have to quickly weigh risk vs. benefit.
3. go to III.
III. Breathe A. If breathing is present, 1. Add oxygen if available.
2. return to I.A. or I.B
B. No breathing, begin artificial respiration using airway established in II. 1. Add oxygen if available.
2. If breathing is restored return to I.A. or I.B
IV. Control bleeding A. Use direct pressure on oozers. B. Use clamps on bleeders and spurters. Note: Take care not to obstruct airway. Use of Kerlex, Kling, and packing may be best done at “Bright Lights and Cold Steel”. V. Monitor all the above A. Check/treat for shock B. Establish IV with LR or D5W. C. Transport/Evac STAT. D. Titrate sedation/pain meds as needed. |
JAGeorgia,
excellent!! cervical 'immobilization with anything and to the best of ability, IV bags, rolled towels, KID, etc and if possible, clear c-spine clinically.
Points to remember....if the airway is working (it was here) leave it alone!!! upright position mandatory....do think about associated thoracic, neck, head injuries. Was an M-80 in the mouth, did cric him in the trauma room, upright and with some lidocaine but wide awake to continue a patent airway. On scene, they tried to lie him flat...mistake!!, tried to fit a collar....mistake, tried to hold firm pressure on neck (patient felt more dyspneic with this).
Overall this can be civilian or military trauma and needs to be dealth with the same. I'll post a follow up pic post reconstruction of a lot of missing pieces.
Good discussion on Rx......
SS