(12 of 15) Post-Scene EMS is dispatched at 0100 to a fo…

(12 of 15) Post-Scene EMS is dispatched at 0100 to a forest preserve for an ATV crash. Response time is 10-15 minutes. You are traveling on poorly lit paved road that leads to a clear opening to the trail. It is a cool fall evening; weather is 40°F. Skies are clear, roads are dry, traffic light. Ambulance is staffed with 2 paramedics and a BLS engine. Your nearest community hospital is 12 minutes ETA by ground and a level 1 trauma center is 25 minutes by ground.Dispatch informs you that a park ranger has arrived on scene. It is confirmed that one patient was injured after being ejected from the ATV. There is a large group of college aged students present and there is evidence of alcohol consumption at the scene. The paved road leading to the opening of the trail is clear and unobstructed. The trail leading to the patient is on rocky and uneven ground.You and your crew are led to the location of the patient with the help of the park ranger. The ATV is several feet away from the patient in the brush and is still running. Pt. presents to be in a lot of pain from an isolated long bone fracture to the right extremity.Patient is a 20-year-old, alert and oriented 4/4. Physical exam finds an angulated deformity to the right humerus, pt. rates it a 10/10 and is in extreme agony. Patient also states “feels like I’m going to vomit.” Pt. states they consumed “1-2 beers” tonight. There are no signs of trauma to the head, or face. The pt. denies numbness, tingling or pain to the back.After removing the patient’s jacket, the right arm presents with a 45° deformity. You see bone protruding through the arm (midshaft of the humerus) with profuse venous bleeding. Pulses are absent distal to the injury. While performing a detailed secondary exam, the patient reports feeling pain to the right lower leg. He describes that the outside of his lower pant leg got caught on the wheel, causing him to lose control of the steering and part of his leg came in contact with a hot spot on the ATV. Assessment finds a partial and full thickness burn to the anterior and lateral aspects of the lower right leg, below the level of the calf, estimating 2% TBSA using the rule of palms.  Select 2 options: {B7CE4EEF-775C-4230-B751-A021F30153CC}.png
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An 45 y/o adult presents with severe R knee pain (10/10) aft…

An 45 y/o adult presents with severe R knee pain (10/10) after slipping on icy steps and landing on a concrete sidewalk. The right knee presents with tenderness, swelling, and deformity. The patient has no past medical history or allergies. Weight: 200 lbs. VS: BP 146/96; P 92; R 16; SPO2 97%; EtCO2 35; lung sounds: clear. What first single dose of fentanyl should be given?
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