Transcript

0:10

Alright. Next session is, dealing with a swimmer who drowns. They they don't have any spinal motion restriction complications. So once again, my disclaimers, we're gonna focus on their patient assessment process just like we did. For those that are joining us just on this video on on demand, we're going to be interactive, and the, the interactive element will be disabled for you if you're watching this, but you can definitely watch us go through this.

0:43

So we're gonna start off with, once again, our minimum equipment check. This includes, medical timeouts. This includes your protocols. Are you ready for that scene? Then we're gonna take a look, heavily at the scene size up related to this.

0:60

We don't wanna go about this too fast. Give it us due respect specifically in in a different scenario. And then we'll begin to take a look at our primary assessment, CAB, and, and do, the interventions that are needed to, to stabilize that patient and, to make sure that we address any life threats during this primary assessment. And that what I call is find it and fix it mode is, like, what are the problems and how do I fix it? What do I do to make it better?

1:32

We're not going into 45 on this one. There will be a a repeat of this session where we review the primary assessment, the scene size up, but then we get into, hey. They respond. So we're gonna see this scene later in a few months. But right now, we'll just get through, 1, 2, and 3.

1:52

So you're summoned to aquatic center of a swimmer report that have drowned. You are quickly on your way. And, you are running, you grab what you got. It's a 18 year old, that somebody says they think they drowned. They're not sure.

2:07

But, so here we go. We are we we we've got our equipment, and we're headed into this particular scene. And we've got a lot going through our mind, as we approach this scene. Another athlete pulled the athlete out. They went unconscious underwater.

2:28

They weren't sure what to do, but they pulled him out. They said they were under less than a minute, and they were nice enough to grab something and put under their head. So let's talk about this scene. What are some issues you should be aware of when responding as part of the scene size up process? So we are using Sladeo once again.

2:52

So this is an open ended question. What are some issues you should be aware of? What what what goes to your mind? What are the bigger picture issues you recall? Somebody is drowned.

3:05

You that's the call that came in. What are you thinking about the scene? What has to be done? BSI? I mean, patients.

3:17

Right? You tell me what you're thinking when it comes to seeing size up. So in the scene size up, we haven't got to the patient yet. We're still on our way to the patient. And, so when we're on our way to the patient, we're thinking more along the lines of, like, there we go.

3:52

Any hazardous slippery services, that would be a worst case scenario that we don't come running into a water area. You would think that would be common sense, but that's not always the case. Somebody is drowned. Do we need to already call 911? Do we need to grab additional people?

4:14

Do we need to call an internal code blue, before we get there if somebody reports? These are the kinds of questions that come up in the scene size of category. Right? Do you need to already have your gloves on? Where is the AED?

4:30

Have they been called? Are there any lifeguard presidents? That's a good one. Right? If they are, where they are and what level of training have they had, and have you had any communication, and do they know who you are, at any capacity?

4:45

There's a lot of unknowns in this right now, but I'm just trying to take a moment to, remind us that we need to account for need to account for all the big issue questions of BSI, same size of MOI, number of patients, like like, what's the mechanism rendered? Do they fall and hit their head? These are the kinds of thoughts going through your head as you go there. Right? From those issues, which one would be the most challenging?

5:13

What do you think? What's the most challenging? What are the most challenging in the inside? We'll go about this pretty fast. What's the most challenging out of all of that?

5:22

Is it again, we haven't gotten to the patient yet. We haven't touched the patient. We haven't started a primary scene. We haven't started a primary assessment yet. What are the biggest global challenges approaching this scene that needs to be accounted for that you would struggle with the most?

5:44

Yeah. K. Here's what I would struggle with. I would struggle with in that scene is, once again, whenever somebody calls me, by saying or seeing anything like that, When somebody calls me, my equipment that I need to manage the really, really bad scenes like this one, do I haul all of that with me when I'm going, or do I get there and then go back and get it? That's probably been my biggest error as a profession is I just take off.

6:34

Right? Yeah. I just take off. And, then, quite often would grab somebody and say, come with me, and and then they would know where my scene is. The biggest thing you have to condition yourself is when you call somebody who is unconscious, that's a different play.

6:53

So what do you do? Do you stop and go to another room and get your equipment before you head out? Because that's gonna delay you about a minute. Or do you just take off and go? And in most cases, you should delay yourself to go get your equipment when you hear the word unconscious or drowning or or like we just got out of our other scene.

7:15

That's the element that athletic trainers, I think, struggle with. Right? And, yeah, I like that. Don't go along. Alright.

7:23

We gotta move on along here. So we have our head going through a lot, getting to the person safely, making sure the scene is safe, getting additional information about the scene as much as we can. We don't have a whole lot. But now we're ready to go touch the patient. Right?

7:42

After you hear the scene and you start your assessment, the other person's you know, your question is how long was she under? They said she drowned. How long was she under? They said less than a minute. Okay?

7:56

For some reason, we don't know why, but but she inhaled water, and now she is laying beside the pool, and you have to begin to make some assumptions. The assumption would be what? This is not a referee using cardiac arrest. This is somebody whose epiglottis has closed down. This is somebody whose heart is probably still beating.

8:19

This is somebody that's about to throw up with very little intervention that you do, and are you prepared to clear the airway? It's a totally different kind of scene that's about to potentially play out with limited information that you're just touching the person. So here we go. What's the first step in your primary assessment? We'll go through this pretty quick, so stay with me.

8:44

It's the first step in your primary assessment. Do we do a job for us? Do we insert an airway? Do we start chest compressions, or do we suction water from her airway? Yeah.

9:00

Yep. We're right on that. We're right on that. I know some people are in here, voting, and I gotta I gotta move a little quicker here because we're running out of time. Yeah.

9:09

We gotta we gotta open her airway first. You know, if we have any issues with spinal motion restriction, we'll do a job for us. After you establish the patient are responsive, what's your next step? Here we go. You're opening up the you open the patient's airway.

9:23

What do you assess next? You check for breathing? You check a pulse? You administer oxygen? Check the patient's pocket for identification.

9:31

What do you think is next? So the moral of this story, just like every story of primary assessment, there is a method to this madness. There is a progression. There are steps, and you start off with circulation, airway, breathing. Quite often done simultaneously are in some sort of sync, but we're gonna check for their breathing.

9:58

And, yeah, we're gonna try to open up that airway, and and and then we will sit down and start checking for for our our pulse. You ensured that their airway is clear fluid. You open it up, jaw thrust or a modified jaw thrust, and you don't see any fluids in her mouth, in her upper airway. She has a pulse, but no obvious chest rise. So you feel a pulse, but you don't see the chest rise and you don't see any fluids in, what's the next step to consider?

10:31

That's what you got so far. You get the ADL. You begin chest rescue breaths. You insert an airway, or do you suction? So my question would be, if she has a pulse, do we need to apply an AD?

10:56

If we felt a pulse, Do you start to ventilate her, or do you insert a nasopharyngeal airway before you start to ventilate, or do you suction even though you don't see anything to suction? The point is you have tools in your toolbox, and you gotta know, based on the scenario, which tool do you bring out and use first. Alright? So hair no water in her airway. You feel a pulse.

11:28

Yeah. You're gonna start to ventilating her. You're gonna start to you're gonna start to breathe into her. You wouldn't put an airway in yet as long as you can get air to go from point a to point b, which that's our question. And the way that we start doing rescue breaths, did the chest rise or not, that would be the first in inclination as to getting that going.

11:51

Alright? Good stuff. You begin to live with rescue breaths. 1 every 5, right, her chest begins to rise, and on the 4th attempt, she begins to vomit. Right?

11:60

So we expanded the thoracic cavity with her lungs, and that put pressure on her stomach. And her stomach, more than likely, she would probably have a dry drowning, which means the water's in her stomach. They have a glottis. It's holding its holding its own. But after the 4th attempt in her chest rising, she starts to throw up.

12:24

What's what's what's happening? What do you think here? How long to suction? How do you log roll or not? Do you do a finger sweep or not?

12:33

Right? These are the kinds of questions that you're going to have to answer as you move through this. Right? So and can you suction with her on her back? Possibly.

12:43

Can you log roll? Well, only point I'm trying to make is it's variable. It depends. The only point I'm trying to make is it's variable. It depends, and you gotta be ready for the depends.

12:58

Yeah. You can have all the fancy algorithms you need, but once again, it goes back to training, and it goes back to, understanding the situation that you have. So interview, equipment check, don't blow past scene size up. It's important things to consider. Follow your steps and protocols.

13:17

The referee with cardiac arrest that we just saw, plus this drowning are 2 people unconscious that their cardiorespiratory system is under stress to the point where one of them or both of them are not working, and you gotta find the problem and fix it in record in in a very fast time. And you gotta be variable in your interventions, in order to fix the problems that are there. Alright. What do you think? Did we confuse you?

13:47

Did we, help clarify some stuff? Hopefully, we motivated you that you need to practice and put up a variety of scenes like this in order to begin to build your confidence in emergency medicine because confidence can only come with repetition and providing variability to your training. What do you think, Ray? Trying to

14:21

get the technology kinda get signed on. Yeah. These these are just two great examples of it it's not a perfect world, and you're having to manage the situation. It goes back to some of the other presentations we've done that that you have to think outside. You know, this is this is being presented with situations or that not may not or may not be outside the box, but you have to be thinking to not get closed in on that box is having, just to go through that mental exercise as well.

14:53

Yeah. This was, again, I think these are very relevant to what and the progression just to ask those critical questions, and and also seeing the the various responses, and how that flow gets into as an exercise. So