EMS World

DEC 2014

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CASE REVIEW He takes some sterile saline and fushes the dirt and glove pieces out of the wounds, using gauze to assist in pulling out the pieces. Bleeding is controlled in all of the digits. There are some pieces of the ring fnger caught in the torn glove, so the paramedic cleans those, places them on a clean piece of moist gauze and puts them into a bag to take to the hospital. He cleans the hand and fngers and straightens out the remnants of the ring and ffth fngers. Since the nails are intact, he uses the pulse oximeter to see if there is any pulsatile fow in the nail beds. The ffth fnger does not register any. The ring fnger does, with an oximeter reading of 99%. He touches the button to check carbon monoxide, and surprisingly the CO-oximeter gives him a reading of 22%. He's glad the ring fnger has pulsatile fow and understands the ffth fnger probably doesn't because of the severe injury, but he wonders what the high CO reading is about. The CO-oximeter reads 20% on the right index fnger, 23% on the left ring fnger and 22% on the left middle fnger. "Do you have a headache?" the paramedic asks. "Or are you feeling bad in any other way?" The patient answers that he's dizzy and has a little headache but thought it was just due to the cold weather. "How long were you using that gas-powered snowblower?" "I just got a few minutes in before this happened. But it wouldn't start and run right, so I was working on it here in the garage for a while. Why are you asking?" The paramedic had noticed the smell of exhaust in the garage but really hadn't paid any attention due to his focus on the patient. He asks the fre engine captain to bring in a gas monitor, and sure enough, the carbon monoxide level in the garage is about 250 parts per million. "Sir, nothing serious, but we are all going to move out of the garage and let it air out. Your carbon monoxide level is high enough in your blood that it alerted our monitor. We will need to put you on some oxygen to clear your system, and blow some air through the garage and keep everyone out for a while. Don't have anyone use that blower until it is repaired. It must be pouring a lot of carbon monoxide into the air." The patient refects a moment. "Maybe that's why I used poor judgment and stuck my hand into the machine." The hand is clean, bleeding controlled, and the fngers are all splinted with gauze neatly on the IV board. They give the patient a plastic bag with some snow in it to use for pain control and cooling, and elevate his hand with a sling. They apply an oxygen mask. The patient receives an injection of pain medicine en route, and the trip to a hospital with a hand-surgery service is uneventful. Hospital Course Staff treat the patient in the emergency department and take him to the operating room for extensive repairs of the hand. He makes an outstanding recovery with a functional hand and most of the tissue intact. It will take him many months to regain sensation in the ffth fnger. Case Discussion Ser ious ha nd i nju r ies may LEARNING POINT Hand injuries are dramatic events. Any pieces of amputated body parts should be retrieved and brought with the patient, in case some elements can be used for coverage or replant. Prehospital emergency care of serious hand injuries includes cleaning, splint- ing, pain control and transport to a hospital that can provide hand surgery. Carbon monoxide toxicity related to the use of hydrocarbon- powered equipment and heating appliances can be present in a wide variety of winter events. Oxygen Generating Systems Intl. www.ogsi.com | ems@ogsi.com OGSI has Oxygen Generators for Every Situation Tel: (716) 564-5165 Toll Free: (800) 414-6474 Fax: (716) 564-5173 MOGS 100 - THE ONLY ONSITE OXYGEN GENERATOR TO OFFER TRANSFILLING AND BLAST   CON- TAINMENT MOBILE OXYGEN TRAILER - EASILY TRANSPORTABLE, TURN- KEY, ELIMINATES DEPENDENCY OF CYLINDER FILLING FOR LARGER APPLICATIONS CFP-15+ - FOR YOUR SMALLER APPLICATIONS, THIS UNIT OFFERS EITHER WALL MOUNT OR CART OPTION cart opton shown MADE IN THE USA For More Information Circle 18 on Reader Service Card 22 DECEMBER 2014 | EMSWORLD.com

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