I have discussed the basics of assessment now let’s put it together. Check mental status and the ABC’s. Address issues as you find them. Then start at the head and work your way down to the feet then do the arms last (legs have bigger arteries so they come before arms).

 

You are cruising down the road, jamming to some tunes, on a rural 2 lane road. A motorcyclist is heading toward you when he looses control of his bike and slams hard into a large tree. You choose to stop instead of driving by and hoping someone else will stop. You find a man near the side of the road 15 feet from the tree he struck. He is wearing a thick leather clothing and was wearing a half helmet. He is unconscious. His forehead, nose and lips are ripped deeply and he is bleeding into his mouth. He is breathing around 14/minute and his breaths are causing gurgling and bubbles in the blood in his mouth. He has a radial pulse of 140/minute. His right leg is sitting at an unnatural angle just above the knee. There is a hole in the leather pants above the right knee, the hole has some bone sticking out, there is minimal external bleeding.

 

What first? What can you do as a layperson to help until EMS arrives? Maybe you have a first aid kit, maybe not. Even if you have a first aid kit is it sufficient enough to help? You have probably heard that you should not move an accident victim. The fear behind this is that if the pt has a broken neck but the vital nerves haven’t been damaged, moving them could cause those nerves to break and the pt could die or become permanently paralyzed. The truth is that if their nerves were to be damaged it happened before anyone touched the pt. move the person as little as possible but withhold treatment because of the broken neck fear.

 

For this person I would raise the right arm above his head and roll him to the right, using the arm to support the head. Why?

Airway – the blood in his airway IS going to kill him and kill him soon, probably before EMS arrives. He is literally drowning. Rolling him to his side would let the blood drain out of his airway.

Why his right? His right leg is messed up, the largest bone in his body is sticking out of his skin. Move this leg as little as possible so rolling him onto the leg will agitate the injury less then rolling him left and leaving the right leg to flop.

This is enough to buy this guy a little time and if this is all you do then you have potentially saved a life.

What else can you do? I’d cut his pants on his right and put a tourniquet high on his right thigh. Tourniquet’s work best on bare skin or tin clothing, heavy leather or thick work clothes can make it difficult to tighten the tourniquet enough to stop bleeding, especially if this isn’t a tool you often use. If a leg gets hit hard enough to break the femur (thigh bone) there is a good chance that the femoral artery got damaged. The thigh is big enough to hide arterial bleeding, you may not see any bright red blood coming from the would until 1-2 liters of blood have accumulated in the thigh. If the femur is broken suspect arterial damage. What if your wrong? Tell EMS that you put the tourniquet on in case there was damage, they can loosen it and feel for pulses in the feet which will help determine arterial damage. I’m not going to get into foot pulses because they are difficult for professionals to find.

 

As a lay person doing these two things can really make the difference between a body bag and a person walking out of the hospital.

Thank you for providing a scenario to put pt 1 in context.

Big Thumbs Up again to MedicYedi!

I carry a C-A-T in each of my vehicles precisely for the motorcycle rider who gets off his bike at 50 mph and gets stopped by a STOP sign post. Along with my assortment of first aid supplies is a fresh non-expired bottle of baby aspirin for the cardiac emergencies, and an awareness of CVA (Stroke) symptoms - even mini-stroke (TIA), treatment for the later is available, but it is time dependent (3 hours), tough guys can easily talk themselves into death or permanent disability by ignoring the signs and symptoms of a stroke.