You are working as a solo Emergency Technician on an RRV when you are called to 19 year old in a public place who has reportedly been stabbed. The scene is 5 minutes away, control contact you to inform that police have made the request, and Officers are currently trying to manage the bleeding. Paramedic backup is on route but they will be 10 minutes. You respond on blue lights to the incident, you see the police down an alley way with the patient on the floor and a lot of blood around him.
As you approach with your kit, you see the 2 Officers are pressing hardly on his lower thigh area. A lot of blood seems to be spurting from under their hands. They explain they were doing their daily patrol when they heard a commotion and someone calling for help. They came down the alley and found the patient with stab wounds to his thigh. The patient was very distressed initially, saying repeatedly “He’s stabbed me, he’s stabbed me,” but the patient is now a lot quieter and just groaning.
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You quickly look at the patient and can see they are a pale and waxy in complexion. There is a large pool of blood around the patient with more seeming to be spurting from what looks two stab wounds to his lower thigh. They seem to be tachypnoeic with a reduced GCS, and are making a grunting/snoring sound with each respiration.
What is your first priority
On the limb injury, what device should you utilise first to try and stem the haemorrhage
You instruct the two officers to continue applying pressure to the wound site as you get out the tourniquet. Where are you looking to place the tourniquet
You apply the tourniquet and start tightening. After the third turn the patient starts to groan loudly in pain and reaches down with his hand to try and remove it. One of the Police Officers says to you he thinks it’s too tight and is hurting the patient. Blood continues to flow from the wounds, what do you do
You explain to the Officer the importance of the device and its’ correct application. The Officer understands and tries to calm the patient. With the tourniquet applied the bleeding has now stopped, the Officers remove their hands and you can see two large stab wounds in the lower thigh. Now that all visible haemorrhage is controlled, what is your next assessment
You note the patient is making a grunting/snoring sound on inspiration. You ask the Police if they have any more information on the incident. All they know is that there was calling for help and when they came down the alley, the patient was leaning against the wall saying “He’s stabbed me.” The Police then laid him on the floor and started to apply pressure to the obvious wounds. A quick look around the head and neck shows no damage, with all this information you feel that the patient hasn’t sustained any C-Spine damage or injury. A look into the mouth shows no obstructions or fluids. With that in mind and a stepwise approach, what can you do to help manage the snoring/grunting
You perform the manoeuvre on the patient and the snoring sound goes. You move onto breathing and apply a finger O2 saturation probe. O2 levels return at 97%. Would you still apply O2 with levels of 97%
You feel that the patient is in a critical trauma situation and apply 100% O2. You continue with the breathing assessment. The patient is wearing a puffy jacket and top. You ask the officers to cut the jacket off so you can fully assess the patient. They cut off the jacket, what mnemonic can you use to assess the patients’ breathing
You work your way through FLAPS TWELVE, you note there is some reduced air entry on the left lower lobe area. As you come to the search part of the mnemonic, placing your hand around his back, you feel a lot of blood. The Officers also note to you that the back of his puffy jacket is saturated with blood. You turn the patient very carefully and expose an additional stab wound on the left side of his mid-back. There is blood flowing from the wound steadily. You get an Officer to place pressure on the wound to stem the bleeding. What in a stepwise haemorrhage control approach can you do to further treat
The dressing and pressure stop the bleeding from the wound. The Ambulance has turned up by the road and the crew are making their way to you. Following your intervention what should you do