So I was asked to go ahead and put some mountain biking related pathyphys down on STM. I figured why not and I'll also put it up here

First things first obviously if you don't have medical training, it is probably best not to mess around with a patient. Too many variables exist to cover all the things that can go wrong. I will provide some treatments that anyone can do along side some that should be reserved for trained professionals because of other compromises. With that careful who you treat. Sure there is the good Samaritan clause that will protect you to the extent of your medical knowledge, but it could burn me if someone wanted to get pissed enough. How I wish I could just say "hey you were dead and I or someone from this site made you less dead". But California is sue crazy so this thread is meant as information of what happens when shizzzle hits the fan.

In all reality it is probably obvious but one other thing that needs to be mentioned. A fracture can only be seen in an x-ray. A doctor or hospital can only tell you if the patient is all better. If someone goes down hard enough, call 911 and do what you can before medics get there. At the same time don't make the patient worse Smiley

Sorry guys had to do the disclaimer thing.

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Team Chode!

Shock

Physiology- Shock is commonly defined as inadequate perfusion to the sustain life. There are three different stages of shock starting at compensatory shock, decompensated shock, and irreversible shock. The patient begins by having an increased heart rate, being anxious, and having slightly pale and cool skin. The body is able to combat the problems with shock by constricting blood vessels, increasing the heart rate, and cutting off circulation to nonessential organs. As a patient falls deeper into shock the decompensatory stage begins. The pulse further increases to >100 bpm, blood pressure begins to drop, skins become pale cool and diaphoretic, and the patient becomes more agitated. Late decompensatory shock is classified for patients with a pulse of >120 bpm, peripheral pulses disappear, and blood pressure falls even lower. The systolic blood pressure will be <90 mmHg. Finally irreversible shock is the third and final stage of shock. This stage of shock is not reversible. Too many organs are damaged from hypoxia when the patient falls into this stage of shock. The patient presents with very weak central pulses, extreme tachycardia that then falls to 0, blood pressure is very low and sometimes unattainable, and bleeding may occur from every orifice and once controlled wounds.
Shock also comes in numerous forms. Different forms are the result of different causes.
• Hypovolemic shock is the lack of sufficient fluids in the cardiovascular system to sustain adequate perfusion. Exogenous hypovolemic shock is the loss of blood due to excessive bleeding, plasma lost from burns, diarrhea, vomiting, Endogenous shock is loss of fluids internally via internal bleeding.
• Anaphylactic shock is the overreaction of the body’s immune system to an allergen or other stimuli. The clinical definition is hypotension that comes on suddenly with or without bronchospasm or obstruction of the larynx. A variety of allergens and foods can cause this overreaction of the immune system in susceptible people. Stings from bees, hornets, yellow jackets, and honeybees are very common also allergies to various nuts, shellfish, eggs, fruit, or wheat. Some patients have such sensitivity to these allergens and foods that they carry a preloaded epinephrine auto injector called an epi-pen in case an anaphylactic reaction.
When an allergen or stimuli entered the body, mast cells release histamines to combat the infection. These histamines cause bronchoconstriction and hives. Basophils, B-cells, and T-cells also are released and have effects on smooth muscle contraction in the airways, increased mucus production and secreation in the bronchi, and vascular permeability. This vascular permeability is a form of the endogenous hypovolemic shock as blood leaks out of the vessels and into the body. Epinephrine inhibits the release of mast cells and beta cells, relaxes the bronchials through it’s beta-2 blocker function, and helps to increase blood pressure from blocking alpha-1 receptors. Antihistamines also help to bring down hystemic effects on the skin and brochoconstriction.
• Septic shock is a persistent heightened dynamic and metabolic state that as it progresses multiple organs functionality decreases. The results of sepsis, bacteremia, or endotoxins causes further decrease of perfusion through the body. Some common bacteria that are responsible for 60-70% septic shock cases are Escherichia coli and klebsiella-Enterobacter. The heightened dynamic and metabolic states are signified by an increased oxygen intake, increased cardiac output with a normal or decrease filling pressure. The microvascular deterioration results from the inflammation of the sepsis, bacteremia, or endotoxins. Through this deterioration capillary membranes leak which reduces vascular resistance, decreasing blood pressure. Septic shock is apparent from decreased oxygen uptake, variable cardiac filling pressures, and decreased cardiac output.
• Neurogenic shock is classified as the loss of control of the vascular system by the nervous system. This loss of control results in blood vessel dilation which causes blood to pool along the distal portions of the body.
• Psycogenic shock is the temporary limitation of blood flow to the brain. Blood vessels will momentarily dilate causing the drop in pressure that limits blood supply to the brain. This type of shock is commonly self corrected when the patient is supine. This is commonly known as fainting in that the patient will involuntary get dizzy or unresponsive and fall to the ground.

Signs Symptoms
• Tachycardia
• Low Blood Pressure
• Rapid Shallow Respirations
• Restlessness
• Altered Mental Status
• Dilated Pupils
• Pallor
• Cyanosis on the lips • Thirst
• Dizziness
• Nausea/Vomiting



Special Questions Pertinent Negatives
• Was the patient exposed to any known allergens?
• Any associated nausea, vomiting, abdominal cramps, or diarrhea?
• Any difficulty swallowing or feeling or “throat closing up”?
• Length of exposure?
• Any dyspnea?
• Is the patient dizzy or weak?
• Have you had diarrhea recently? How many times have you had a liquid bowel movement?
• Have you been vomiting today? How many times and how much liquid came out? • Location of sting or bite?
• Stinger still present?
• Any cyanosis?
• Any stridor or wheezing?
• Any facial or peripheral edema?
• Any rash, erythema, hives, urticaria, or localized edema?
• Medic alert tag?

Basic Treatment

-Hold in line stabilization (hold the patient's head in line with the rest of their body to prevent spinal cord damage)
-Make sure the patient can breath. If the patient fell off their mountain bike and there is a possibility of a neck or spine fracture the technique to open an airway would be to perform a jaw thrust. You could probably find something on youtube. If there isn't a suspected spinal injury then an airway can be established by pressing down on the forehead at the same time as lifting the chin. Essentially their nose will pointed almost vertical.
-Lift the legs and cover with a blanket to keep warm. Careful with this treatment in that if it is a head injury and the patient is bleeding in their brain, this will make then worse. In the case of a spinal fracture this is also bad in that lifting the legs can exacerbate a spinal injury. Shock has signs and symptoms of increased pulse (normal range is 60-80) decreased blood pressure (120/80 is perfect) and skins that will look pale, be cool to the touch, and sweaty.
-An Epi pen is something people carry that is an instant medication to fight off anaphylactic shock. This is very effective treatment but can also harm the patient if administered wrong. The epi pen injection site is Mid thigh on the outer portion into the meatiest part of the muscle. The pen is designed to inject itself into the leg so it needs only to be held against the leg with enough pressure to activate it and long enough for all the meds to get in.

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Team Chode!

Thanks for this Doug. Hope this never happens to any of us.

I just realized that some of the terms here are medical terms. The ones that stuck out most were Tachycardia (tachy-fast, cardia-heart=fast pulse) dyspnea (dys-difficulty, pnea-breathing=difficulty breathing) systolic (the top number on a blood pressure) cyanosis (skin that turns blue from lack of oxygen) pedal edema (pedal-feet, edema-blood pooling under the skin=blood pooling in the feet)...PM me or toss up any others I missed

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Team Chode!

You must be going to some kind of medical school?
My 17 yrs who is going to be a senior is interested on nursing school, will see.

I'm in paramedic prep. Sounds good that your 17 yo wants to be a nurse. If I had that kind of patience for patients I'd try to do the same. Nurse can make great money, start with less debt, and have awesome travel abilities

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Team Chode!

Spinal Precautions

Because we are in an extreme and heavy impact sport there is a good chance for spinal complications in the trail. If there is a crash on the trail that requires medical attention a good thing to keep in mind is spinal immobilization. A quick refresh about the spine (though it is probably painfully obvious, here goes). Your spine is a protective bone system that protects the very important spinal cord. The spinal cord is the direct passageway from the body to the brain controlling bodily functions. The spinal cord is also responsible for reflexes. In the event of a crash involving a back injury there is good chance the spinal cord will become inflamed and swell. This can cause people to get a tingling feeling in their limbs which is can be temporary. However, due to the increased size of spinal cord and razor sharp edges of broken bones, the spinal cord can become severed. If a rider goes down and goes down hard enough that he should go to the hospital this is where spinal precautions can help.

To actually immobilize the spine is easy enough. Hold the down rider's head so that he doesn't move it around. Don't worry about straightening him if you are by yourself or with other people who don't know what to do. Just tell the person to not move and lay still as you hold the head in place. If you feel confident on moving the patient, be careful! Like I said the spine is razor sharp and he can sue if things go wrong. But nonetheless this is best done with as many people as you can find. There is a reason 6 fire fighters come rushing to any accident. You pretty much need 6! Anyway, get a flat surface so that the patient can lay flat. Straighten the limbs out slowly and in unison. To describe it is almost impossible and I'm keeping this vague to inspire people to leave this one to the fire fighters or other safety officials. Before you lay the patient on his back it is a good idea to lift or cut his shirt off to see if there are any obvious lumps bumps and bruises. This will be helpful when medical professionals get there. You don't need to know what it is but saying "there is something funny on his back right there".
Indications that the spinal cord has been compromised. If the patient lost control of his bowels (incontinence). Another indication is if the patient has an erection (priaprism). These are both bad signs! They indicate a lower lumbar fracture, severe, or reversible problem. Another indication is the loss of feeling and motor ability in the feet or hands. Ask them to wiggle their feet (gently!) and fingers. Also grab a toe and finger without them looking and ask them to identify. The big and little toe on either foot and thumb and pinky on either hand. Loss of motor or sensation in their feet indicate a lower lumbar problem. If the patient lost motor or sensation in both feet and hands this is an upper spinal problem. If the problem is high enough such as around C-3/4 the patient can stop breathing. This where things go real bad! If your buddy has any of these signs or symptoms he needs to go to the hospital and you should encourage him to do so. Christopher Reeve ring any bells?

There is no true way in the field to rule out a fracture of any bone (if the arm is bent the wrong way or sticking out is usually a good sign that it is but lawyers suck...anyway). The only way to know for sure that the patient's spine is intact is with an x-ray. If you see a buddy go down on a rock or off of a big enough jump these are some good things to look for to help convince them to go to the hospital. These are true emergencies! There are stories of people who don't feel any pain after a crash because of the adrenaline and end up paralyzed because the spinal cord get severed from the unknown broken spine. You don't need to be too paranoid that everyone that falls is in danger, but try and make an educated guess, you could save your buddies legs and possibly their life.

Go get them hero






....ok maybe that was a little too much

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Team Chode!

Some good information here, thanks for sharing FW. Because we participate in a sport that is physically demanding with a high potential of sustaining injuries its a good idea for everyone to take a class in basic first aid and Basic Life Support (BLS) or at least be familiar with it. A quick but thorough primary survey (ABC&D) with a rapid EMS activation are essential for greater chances of survival.

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-Randy

I just make sure to ride with you

Sounds like I have my next topic when I get bored.

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Team Chode!

You forgot "Stop the breathing and start the bleeding"
or is it Stop the bleeding and start the breathing...that one always confuses me.

"Air goes in and out, blood goes round and round. Anything different is bad" Is another fav

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Team Chode!

knife goes in -- guts come out.