The best EMS Test Question!

[hageremtp]

Any one that can answer this one, I will give you great credit.


Think back to your EMT-basic training. You were told that whenever you find a bleed that is bleeding a lot you need to control it. You to this by a 2x2 (4x4..etc), direct pressure, and elevation. If the bleeding continues then you need to add bandages. After that fails to control the bleeding you should locate the pressure point and apply pressure to stop the bleed. This is what ever one is taught right? Lastly if you cannot get the bandage method to work, you can resort to a tourniquet. So just for fun, I want to know the answer to this. Lets say your called to the home of a 72 y.o male who has a hemorrhoid problem that is bleeding copious amounts of blood. You bust out the 2x2’s but wait who will apply direct pressure? You or your Partner. I know I don’t want my hand in someones butt crack….but the 2x2’s fail so you add more 2x2’s. Lets say that they continue to bleed and you need to locate the pressure point to control the bleeding. Anyone know which pressure point controls the blood supply to the rear end???? Then I want to know, if you cannot get the pressure point to work, and you need to apply a tourniquet, where the heck would you place it in order to ‘stop’ the blood supply to the hemorrhoids?


Any thoughts?
:D

[eyeOthestorm]

I would try packing the area with cold pack and trauma dressing. Place pt. in shock position. place cold packs at the umbilicus level, low abdomen, and over the iliac crests as this is the closest you will get to pressure points. Large bore's etc... and if you work where I work.. RUN LIKE HELL!! :D

Great question! LMAO! :rolleyes: :D

[CollegeBuff]

Well, if the blood is venous, I suppose the femoral pressure points would help some.

[bigJ164019]

Hager:

You are TOO much!!:D :D

[eyeOthestorm]

CollegeBuff,
After chatting with our doc..After we woke him up for a stubbed toe LOL
He thinks that the femoral would be too low and that the area we are trying to stop bleeding in is supplied by the arteries that come through the iliac crest area... Hmmm don't know about all of us and this question..LOL :D

[fre156]

Hageremtp, you're a riot!!

I truly have no idea what the answer to your question is, as fortunately I've never had that happen. The only thing I'd know to do is stuff him with 4x4's get my partner to apply pressure, squeeze his butt cheeks together and drive like hell to the hospital. LOL

[DaSharkie]

You bust out the 2x2’s but wait who will apply direct pressure?

The junior of the two. Seniority has its privelges. :D

BTW, screw the 2x2s. In all seriousness, break out the trauma dressing, have the patient sit bolt upright with their upper body weight on the buttocks. This is about as close to direct pressure as you can get. Perhaps some ice packs may help too.

[IAMedic]

Hager you are a *****. Now, I have to tell you about the worst call of my life!!

We get toned out for Automatic Aid to a neighboring town for "Ill woman". We arrive, First Responders standing pointing to a bathroom. We get there and this 70ish lady says "something fell out" as she is sitting on the toilet. It turns out that her uterus has prolapsed, which I now understand is quite common in the elderly. I am gagging, trying not to vomit in front of my patient and my veteran partner looks at me dumbfounded. The only thing that saved me was this had happened several months earlier to a crew on my volunteer department.

So, here's the exam and treatment we provided. The toilet was filled with blood. We used trauma pads and covered her uterine with them. We then set down absorption chucks on the cot and helped the lady to the cot. We again, wrapped some more pads around the uterine once on the cot. The lady is holding the mass and is doing a wonderful job, I must say. Because there is no way I would have been able to keep my composure, if I had to do it. Covered her up and took her out to the rig. Started an NS line @ TKO, Monitor (NSR 70's w/o ect), and oxygen 2 lpm via NC with sats running 97%. Approximately, 100-300 cc believed to have been in the toilet, but it is very hard to tell.

Dropped her off at the ER and disinfected myself, the cot and the rig very, very well and it took a long time. I need to "think" about this call for a while. But, RN's said we handled it appropriately as there was not much we could do.

This belongs in another section, but I DID NOT FOLLOW-UP WITH THIS PATIENT. Just FYI...Thanks Hager for bringing back this memory!! :D

[fre156]

Ewwwwwww!!!!!!!! :eek:

IAMedic, that's so interesting. I've heard of the bladder coming all the way out before (especially in women who've have multiple children) but I've never heard of the uterus doing that before. Wow!

Stories like this make me sooooo glad I don't have any children. I wish to remain intact. :p

[ff7134]

First of all this is a Medic run!!!!;) So sorry medics this guy needs a line!

[smurfe]

I would have to say, shove a trauma dressing in the butt-crack, tape the butt cheeks together and treat further with high doses of diesel fuel. So, we wanna share some gross images we have seen huh? Well, I have seen a few prolapsed uterus's, very gross, seen a couple prolapsed rectums. I have 2 that stick in my mind though, first was at an MVA a gal hit a guardrail which went Thur the vehicle front to back and eviscerated her. Every bit of Intestine was laying on the passenger side floor. SHe was totally with it and alert. They always say never put them back in but we had to sort of, got her out and more or less just piled them up on top of her. Have you ever tried to pick up 20 some feet of intestines? Gal was lucky, she only lost 6" during surgery and made a complete recovery with no infection. But the grossed I have ever seen was called for an OB. Pull up to the scene and the gal comes walking out of the house. Walk up to meet her she says she had a miscarriage and wants to go to hospital. We say OK lets get in the truck. As she steps up into the side door, I see a 3"-4" fetus swinging from between her legs by the cord like it was bungee jumping. Looked like a little Skeleton Doll. Totally grossed me out. To make it even more gross, the poor little fetus I guess was still alive sort of as it had movement. Yeah, I have seen lots of other gross stuff (decapitations, 100% burns, total body obliteration etc) but this call is the one that I always go back and visualize.

Smurfe

[IAMedic]

Ok smurfe, you have my vote!! Skeleton baby probably would have put me over the top!! YUCK!!

[ABMedic]

Sounds like you need to page for a specialist:



"PAGING Dr. RECTUM, Dr. IVAN RECTUM" who should know how to control bleeding from above or below the pectinate line. (anatomical reference)

[ABMedic]

It appears that the good Dr. Ivan Rectum is obstructed in traffic at the corner of sigmoid and anal.

Options - that have been suggested:

1) ice pack - results in 72 yo patient having severe vagal stimulation - bleeding slows and eventually stops as the patient is in asystole. (One potential therapy to obtain hemostasis)
2) external pressure - could work with time but serious career implications from new nickname given by nurses, docs, fellow medics -aka "captain anusol" etc. (where is that firefighter, EMT, student again)
3) internal pressure - internal hemorrhoid - finger (where is that firefighter, EMT, student again) or perhaps a foley catheter.
4) epinephrine soaked gauze directly on the external hemorrhoid that is bleeding (again where is that student, EMT, firefighter)
5) Pressure points - since the lower rectal wall arteries arise off the iliac - somewhat invasive therefore problematic UNLESS your the student, EMT or firefighter - please see item list 2, 3 or 4.

ABMedic

[hageremtp]

BTW, screw the 2x2s. In all seriousness, break out the trauma dressing, have the patient sit bolt upright with their upper body weight on the buttocks.

Sounds close to what I would do, but hey....what about elevation above the heart? :D :D


I asked this whole question to one of my squads that I do monthly training for, and they had a blast with it. Thought you all might have fun with it.

[MD32gun]

HELL I WOULD HAVE MY PARTNER GRAB THE HEMMOROID WITH SOME HEMOSTATS AND THEN PLACE A RUBBER BAND AROUND THEM LOL!

[IAMedic]

Originally posted by MD32gun
HELL I WOULD HAVE MY PARTNER GRAB THE HEMMOROID WITH SOME HEMOSTATS AND THEN PLACE A RUBBER BAND AROUND THEM LOL!

Owwwwwwwwww!!! Man, I have met some crude and sadistic people in my life, but you take the cake MD32gun!! I cringed and puckered as I read your post. lol :D

[LandsEnd05]

I was going to mention elevation above the heart but that could get interesting, couldn't it?:D
Smurfe gets my vote for most disgusting call with the skeleton baby. Creepy! I've seen the prolapsed uterus, didn't bother me all that much but maybe that's because I'm a woman. Funny how different things affect us.

Remind me again, why I'm doing this work????:D :rolleyes:

[hageremtp]

The rubber band idea works well, we use it on the farm alot. Its a quick easy way to castrate goats and sheep. Usually dont use it on the calves but some of our neighbors have. Works good!

[LadyCapn]

Careful Hager, I wouldn't say that too loud..........your wife/girlfriend just may get some ideas.........:D :eek:

[bigJ164019]

Originally posted by hageremtp
The rubber band idea works well, we use it on the farm alot. Its a quick easy way to castrate goats and sheep. Usually dont use it on the calves but some of our neighbors have. Works good!

It does work well on calves also.
Just keep em away from me!

[NewEMSGuy]

As for who applies pressure... that would be the patient... besides the yuck factor it would probably be less embarassing for the patient if he did it himself.

As for which pressure point and where to tourniquit your that's what the medical director is for, ha.

[Weruj1]

I am on the packin of the crack with surgipads...........multi trauma drsgs...........and thank god for only 10-15 min TR times ........