It has been a busy afternoon as the local schools are out for the Thanksgiving holiday. You've shift traded to get a longer vacation and are working with a newer paramedic. It's not long after dinner when you're paged out for a motor vehicle collision with an ejection.
The details are hazy, but first responders on scene report a young man was thrown from the bed of a small pickup truck.
As you arrive, you notice the pickup truck involved appears undamaged and a crowd has gathered along the curb. You're met in the road by the officer from the engine company who tells you, "the kid was lucky, seems fine; thrown from the bed after they hit a pothole."
The facts appear to be that the pickup was traveling around 45 mph when it struck a pothole throwing the patient–who was sitting in the bed on the wheel well–out onto the street, remarkably landing on his backside without incident.
Your partner passes you and begins his patient assessment.
- Conscious, alert and oriented to person, place, time, and event
- Answers all questions appropriately and without hesitation
- Denies neck or back pain, no pain to palpation of C-/T-/L-spine
- Pain to palpation of left knee, thigh and hip without deformities, crepitus, shortening, or rotation
- Good pulse, motor, and sensory function in all four extremeties
- Denies alcohol or drug use
He concludes spinal immobilization is not necessary and directs a first responder to let go of manual inline stabilization.
The patient's father has arrived on scene and asks that he be taken to the local hospital for further evaluation. The engine company helps lift the patient to your stretcher and secure him for transport.
Your partner says, "I've got this," and you begin routine transport to the local ED. Vitals are obtained in the back of the unit.
- HR: 60, regular
- BP: 118/72
- RR: 18, unlabored
- SaO2: 100% on r/a
A further interview reveals no past medical history, no medication usage, NKDA, and only seasonal allergies.
Given the routine nature of the transport, you're a bit suprised to see your partner's head appear in the pass-through holding a 3-Lead, "does this look funny to you?"
At the next stop light, you take a quick look at the strip and ask to see another. He hands you a second strip.
A pile of strips is forming on the bench seat while the car behind you honks impatiently, he continues, "here is the weirdest looking one!"
His next question is short, "should we divert?"
Update 18 July 2011 17:24 EST
As you arrive at the ED your partner hands you the following 12-Lead.
- What do these rhythm strips show?
- What does the 12-Lead show?
- Is there cause for concern?
- Does this patient require immediate treatment?
- Do you divert from the local ED to a larger hospital with specialists?