En RouteThe paramedic is dispatched to a residence for a 65-…
En RouteThe paramedic is dispatched to a residence for a 65-year-old patient who fell off a ladder. Dispatch reports the distance was approximately 14 feet. The time of the call is 1300. The response time is 10 minutes. The paramedic is partnered with an EMT, no additional resources are available at this time. The weather is clear, and the temperature is 77F (25C). A local community hospital is 15 minutes away and a comprehensive medical facility is about 25 minutes away. On Scene The patient (62kg) is found laying on the ground on their left side. There is an overturned ladder nearby. The wife reports the patient was cleaning out the gutter when she heard a crash. The patient was initially moaning but now she cannot wake him up. The patient has a history of hypertension and takes hydrochlorothiazide and atenolol. The patient is allergic to sulfa drugs. The initial exam is pertinent for pale, clammy skin. Blood and vomit are noted around the patient’s mouth. There is obvious deformity to the right leg with pooling of dark blood under his pants. The patient moans and draws his arms to his chest when the trapezius muscle is squeezed. A weak carotid pulse is present. Respirations are 28 and shallow. Post Scene The crew suctioned the patient’s airway and is currently providing ventilatory support with a BVM. The patient was secured to a long spine board and transport initiated toward the trauma center. A rapid trauma assessment reveals the following: pupils 6mm and minimally reactive, bleeding to the posterior head that is controlled, trachea is midline and no JVD, bruising over the left chest with equal rise and fall, abdomen is soft and nondistended, pelvis is stable, open fracture to the right thigh with bleeding that is dark red and oozing. Vital signs are BP 145/80, P 62, RR 10, SpO2 90% with a BVM at 15 LPM.