Trauma surgeon from an Eastern European country here

If I was doing 120mph, and I hit a car head on that is doing 60mph, and I am ejected from the window, through a barbed wire fence and into a field, how dead should I be? And what if I was doing 60?

On some track days like the Touristenfahrten on the Nürburgring, HANS is forbidden, because it makes turning your head around to look impossible. I'm usually still wearing my helmet on such track days, but I thought better having a wound on my head or some minor trauma than a broken neck. The rollcage should at least make up a safe space for my body.

Would you ever recommend a motorcycle or are they just suicide machines?

ABC first, (yes we use ATLS here) check for Pelvis fracture, reg. trauma series for imaging.

Then get some x-ray's on that foot. If compartment > fasciotomy and external fixture and a referral for the orthopaedic surgeon.

Quite dead in both cases. But who knows, you might be the lucky exception.

I didn't know that, makes sense from the perspective that it's public driving and you aren't supposed to go a million miles an hour and anything you do is your own fault. With better visibility you mitigate potential crashes but HANS let's you survive them.
Ethical debate really.

Motorbikers are nice leather sacks filled with donor-organs.
You are always fucked on a bike.

whats the worst crash youve seen? whats the worst you have seen somebody survive?

Have you yourself been in a crash?

What car do you drive? Bike?
Do you like to do hektik skidzz?

what is best kind of vehicle to get in a crash with, like a giant suv or a new model sedan etc?

> you are always fucked on a bike

that's why you avoid accidents

Not OP but it's well established the safest car in the world, period, is the Tesla Model S. It actually broke the rating scale when tested and was scored a 5.5 out of 5

Ohboyherewego.gif

Hey there!

What can be done if I find my leg trapped after a crash in the dashboard?

Pardon the English.

Biker who apparently flung of his bike and hit a big truck.
He was a four double amputee when he arrived in the trauma room with mush for a body, all his organs pelvis and ribs were shattered, miraculously he still had a pulse but passed away quickly.

Worst situation someone recovered from was being run over by a big lorry.
We had to perform a thoracotomy for heart tamponade (picture in OP) which has about a 2% survival rate in blunt thoracic trauma. She had an entire deglovement of the chest. shattered pelvis.
We did DCS, filled her with our entire blood bank and somehow she made it.

Yes, but I drive a Volvo SUV, so little happened to me.

Volvo XC90 T8. I still own a bike from before my studies but I don't drive it anymore.

Giant Volvo's.

I see how that turns out for them, they still crash more frequently then Americans leaving cars & coffee in a Mustang.

I give you better chances in the new Volvo XC90, there's a reason I bought it. I want my family to be safe. Not to say that the Tesla is bad, it's very good also.

Call your local emergency service.

I've sometimes wondered on long trips, if I am sitting in the passengers seat in the front, and I have a few seconds to react to the crash (head on, or collision into a pole, or a wall), what should I do with my body? Is there a position I can take to make sure I get off with the least amount of harm?

>I give you better chances in the new Volvo XC90,
When they went to test the Tesla's roof strength for a roll over crash, it broke the machine. It was estimated the Tesla Model S could have 5 modre Model S's on its roof before starting to buckle. Mind you this is a sedan that weight 2 and a half tons. They're incredibly strong.

And the Tesla has something else over the Volvo XC90. You can't roll it over. They tried when doing crash testing, but it's so heavy and the center of gravity was so low they couldn't do it. They had to build a special machine just to flip the Tesla.

The Tesla Model S is so overbuilt for safety that it makes Volvo engineers blush.

Don't tense up, but you will regardless. Don't put your hands or feet out, try to sit like a crash test dummy.
Better to be asleep or really drunk.

Unless you drive a old or crappy cars roll-overs don't really kill you never seen anyone die from them on my table at least. A lot of the energy of the crash is expended making the car go upside down.

Whilst it did very well other have received the same ratings, and had more favorable reports overall, than the Tesla S.
Look at the Euro NCAP ratings which are very detailed.
Tesla = 5 stars, XC90 = 5 stars.
Occupant safety:
Tesla = 82%, XC90 = 97%

But that is all for beta engineering buffoons.

Tesla's are low and will slide under trucks.

You might be able to avoid accidents by being a good driver, but your skill won't protect you if Sue with her five kids in her MPV cuts you off whilst changing lanes at 100 km/h.

How long did it take you to become desensitized to all the fucked up shit you see? Is there anything that bothers you still as far as trauma goes ?

Do you ever feel guilty if a patent dies on your table? Maybe thinking if you'd done something differently, you could have saved them?

Or if someone slams the brakes infront of you.
Happens very often, the biker's crotch then slams against his gas tank which can lead to a fractured pelvis. which is very dangerous, a fractured pelvis can lead to massive internal bleeding.

Videos are worse then real life. but the thing that keeps on bothering me are children. Not just because of what you see but also because of the parents.

Is it true that men are extremely likely to lose their junk in a motorcycle crash?

>
I'm sure. As a parent, that would be the ultimate pain. Just to see that pain in someone would probably be pretty difficult.

I used to rather frequently, it still sucks but I came to terms with the fact that I'm just human and there's only so much we can do. Besides we have a protocolled system which makes decisions easy and based on findings. So there's usually not a question of what to do but if we should do it.

The penis is a squishy member, can handle a lot. Your pelvis may shatter but your cock will usually keep on going.
Tuck upwards for safety

It's the worst bringing the news, never gets any easier.

I used to be an EMT, albeit in the USA.

Can you tell me what pet peeves you have in terms of dealing with them, if any.

Thanks for sharing OP. This has been an interesting thread.

EMT's generally think they are hot shots.
You guys can't intubate, neither can I, only anaesthesiologists can, just don't think you can.
You guys always put the pelvic binder way too high.
Everyone according to you lot apparently has cervical trauma.
And you apply tourniquets for a small scrape.

And in general to fluffy when doing a summary. I want vitals, ABC, progression of vitals, what you did and mechanism of injury, not the patients relations with his daughters friends hairdresser and spare me your /dd

What you lot do is great, it's just that everyone in medicine thinks they are the best whilst we trauma surgeons actually are... oh wait.

I read somewhere that no matter how good the biker and how good the driver is in a crash, gravity always wins in the best case scenarios for a bike crash.

Ergo; even the perfect crash for a biker still fucks them up.

What are the worst car brands for crashes, in your opinion?

Do u have to work under pressure lots

There's being lucky enough to be not dead, and then there's literally only having a bit of amnesia, a broken jaw, left arm and right wrist. I was back in full time work two months later. I just don't remember the accident and there was a suggestion I was doing 120, but I think I quite clearly wasn't.

Tiny cars, old cars, tiny old cars from the 90's are death traps. They weight nothing, the crumble like cookie.

Yes, but most of that pressure is alleviated by the ATLS protocol which gives us a hold-on.

It happens occasionally, very very lucky for you, we once had a mention of an accident, which was so bad we prepped the large trauma-team including some extra people, pre-initiated the massive transfusion protocol and the guy only had a tiny cruries fracture and some scratches despite being flung from his car onto the pavement.

I'm pretty sure the threat of his patient dieing on his hands would be considered pressure........

classic cars all death traps?

exceptions being old Volvo's, Saturn's, and Fiero's. The Fiero is the safest classic car you can buy without airbags.

Have you ever had to prioritize patents due to a large influx of incoming victims?

>You guys can't intubate, neither can I, only anaesthesiologists can, just don't think you can.
Really? What happens if someones airways are collapsed shouldn't they be allowed to do it

Pontiac Fiero?

Yes. The chassis was extremely overbuilt. None of the body panels are load-bearing. You can remove all the plastic body panels and drive it around with no detriment to safety. They used a high-tech steel space-frame which was constructed much like the roll cage of a race car.

Got rear ended by a guy in a Fiero when I was a kid. My mother was driving an 87 Camaro and dude rear ended us while stopped at an intersection doing about 60. The cops said judging by the skid marks from his attempts stop he'd been doing almost 80 when he saw us. His nose literally threw our ass up and out of the way, though the differential opened his roof like a tuna can. Only damage to the Camaro was a bent frame and the back seat got broken from the speaker box my mother had in the trunk.

Is that why everything is a fiero with a bodykit?

Yup.

Reverse the positions (Camaro rear ending a Fiero) and your mother likely would've been killed.

Neat, that's nearly exactly what they did, except for the external fixture. I ended up (2.5 years later) with a total ankle fusion.

In this order
>fasciotomy
>corrective surgery (two screws in Talus)
>skin graft
>tibiotalar fusion
>subtalar fusion

I am a paramedic in Florida, Paramedics here are allowed to intubate

AMA

Where in FL

Where you from op?

I won't give exact location due to my employer but Iive on the west coast

Worst you've dealt with? Any "helpful" passerbys?

Is 1991 Toyota Celica SX (GT for you Americans) safe or not?

death trap.

Cool, at least I know now.

I recently got a motorcycle and this thread has scared me more than anything else I've read about safety so far.

So far I have been practicing ATGATT but I feel like that doesn't do so much in real collision. I read that pelvic fracture are one of the most serious injuries in bike accident since alot of nerves run through there. To mitigate that I bought a pair of dainese pelvic protection undershorts that have armor all around the the legs and a hard plastic piece protecting the coccyx (sp?). Will this realistically protect me from some damage or are bike really just s death trap no matter what you're wearing ?

Just not Volvo's and old Land Rovers.
Triage in large events isn't done by me, so no, those decisions are hard because protocol doesn't care for emotions.
We usually slap on external fixtures because that's quick easy and I can do it. We try to minimise the initial surgery time to 1-1,5 hours, it's better for the patient because he can recover a bit and our orthopedic guy can make very proper detailled assessment and prepare the next surgery well.
Wel I don't mean you can't but usually emt's are very bad at intubating. Got my language a bit messed up there.
They do it too little too be good at it.
Close to Russia.

> Worst you've dealt with?

1/2

As a general rule of thumb its thats not really a good question to ask people working in this field because we see and deal with so much fucked up shit and they're discovering that we can become subject to PTSD just like military can. I'm okay with it though. Im early on in my career so its not too juicy yet but here are the highlights:

> entire family wakes up on a sunday morning to find that dad died of a cardiac arrest (we worked him for 30 min. before pronouncing him dead while they watched the entire thing)
> miscarriage at a burger king restroom
> motorcyclist got shot in the head by a shotgun, gunman shot him for no apparent reason (you would think it was road rage or a drug deal gone bad but the investigation revealed it was completely random) his helmet strap was inside his head
> guy completely covered in his own shit having a non stop seizure: his piece of shit wife sleeps in a different bedroom on the other side of the house and didn't know how long he had been like this
> motorcyle accident victim experienced lung collapse, we attempted to decompress his chest using IV needles but didn't work, as soon as he was in the trauma room at the ER the trauma surgeon cut open his chest (without any sort of anesthetic) and split his ribs open to evacuate the air which was compressing his lung. I have never heard someone scream so loud and while I generally try not to emphasize with the pain my patient's experience (this keeps the sanity) I almost fainted at this one because I put myself in this guy's shoes.

tfw you drive a fiero :$

2/2

We have pain medications we can give people, however, we generally don't use them because we're too busy attempting life saving procedures and re-evaluating to see if those procedures worked (we tend to drive pretty fast while this is happening so we won't get the luxury of time to draw up the medication, oh and we're required to ask the patient if they might be allergic to this medication and in this situation the patient was not lucid enough to communicate. Often times the patient's traumatic condition may also contraindicate the use of those medications due to loss of blood pressure.

> Any "helpful" passerbys?

Passerby's don't usually help us, let me explain. If you see something and want to communicate the problem to us the biggest thing we ask is give the 911 dispatcher the exact location and be extremely descriptive of what is going on.Often times we get called out to a dude sleeping on a bus bench. Nine out of ten times that's a bum taking a nap, and there's no need for cops, fire/ems to get involved. The bum hears the sirens and wakes up, goes and hide behind an alley way or hops on a bus and we spend time looking for him which is a huge waste of time and resources - let the bum take a nap. If you see something substantial like a car accident then always always ALWAYS give an accurate location of the crash one car in the right hand shoulder of the north bound lane just NORTH of the intersection of elm street and main street the other pulled off into the gas station on the corner. Try to give the dispatcher a heads up of how many people there were in the car, give a description of the vehicles involved and the amount of damage.

Just give as much info as possible really. I don't really encourage people to stop for emergencies because even if you have any sort of training or you're an off duty fire/police/paramedic, you don't have any equipment to assist. What works best is if you deliver very detailed information to the 911 dispatcher.

Forgot name.
No, but better then most earlier cars.

Forget about your nerves, that is for a later time, pelvis fractures kill you because of massive venous haemorrhage, leading to shock and death.
Coccyx doesn't bleed nearly as much.

Your pelvic shorts will help against big bruises, if the force is enough it will still break, and in many cases the pelvic fracture occurs due to the leg shooting up.

Worst case Pelvic is open book fracture, (which happens mostly to motorcyclist when they hit the tank with their groin, then you can wiggle everything around and sometimes the groin is split.

If you suspect a pelvic injury, don't wiggle it, and don't let the patient try and move.

Femur fractures are also dangerous, you can quickly lose 1.5 litre of blood from a femur fracture.

> motorcyle accident victim

Bad practise from surgeon, a thoracostomy with drain would be enough, I see no reason to split ribs? Unless he did a thoracotomy which is a last resort and you definitely don't do on a patient with an EMV above 3.
Btw we don't even do needle decompression in the ER since it doesn't even work properly.

The needles were used en route to the hospital. The trauma surgeon placed a chest tube inside and he was later anesthetized. I don't know much beyond that because I became sick and never bothered to follow up.

Probably thought he was cool hot shot doc then. if he has a decompressed lung you are having a mask with 15L of 100% O2 on him anyway and plenty of time to let anaesthesiologist do a RSI and intubation before making the incisions.

I forgot to mention that there was another trauma patient in the next room that needed emergency surgery so while he was preparing to go to the OR our patient came in

Don't you have at least a minimum of two trauma teams in the US?

My hospital isn't even a lvl 1 trauma centre and we have always four teams available. with four trauma rooms of which two hybrid.

If someone loses a leg or an arm does a good tourniquet or two completely stop the bleeding?

Fuck off with this disgusting photo.

Someone please ban this motherfucker.

It depends on the trauma hospital (and state regulations)

in the case of the motorcyclist it seemed like he was by himself, but there was a time where a pedestrian got hit by a bus with massive pelvic trauma and he had the ER doctor, trauma doctor, and anesthetist providing his initial care PRIOR to going to surgery

>Any "helpful" passerbys?
not in the medical profession myself.
My sister used to be an EMT. One night, around 9PM, we were walking out of a Subway after getting dinner to bring home. Just about to open the car door to get in, when I see something small coming out of the corner of my eye. Guy on a cruiser bike was speeding through the main thoroughfare just as a SUV (A black Nissan Xterra) was coming out of the Subway parking lot.
BAM!
My sister went into EMT mode and went to help the motorcycle rider. Oddly enough, another woman ran from the parking lot to help. Turns out she was an off-duty nurse from the hospital literally a mile up the road. I called 911, put our shit in the car and calmed down the mother and daughter in the SUV while my sister and the other woman stabilized the motorcycle rider until the ambulance could come.

Motorcycle rider tried to sue me a year or so later saying I caused the accident. It was thrown out for making 0 sense. Just a nigger trying to make money off an accident caused by his own stupidity. If it weren't for my sister and the other woman, He'd have likely died.

Baltics?

Tell me about your most difficult patients.
And can you compare from experience how much difference a seatbelt can make?

Wat? You didn't even open the door and he tried to sue you?

Did he see that he wouldn't get anything from the SUV lady and tried to go after someone that he could soak a good payout from?

Aww did your feelings get hurt?

Are you 9 or something?

Med student here, cool thread

Do you have any advice for a kid starting clinical rotations?

The car, a Chevy Monte Carlo Z34, was parked on the street. He claimed the SUV couldn't see him coming because a woman in an SUV couldn't see over the car. Which is bullshit. It was thrown out because the car is so low, no one, especially in an SUV, has trouble seeing over it.
There were spots on that area for parking on the street so it was legal. After that accident, the town changed it and there's now a no parking sign there. But at the time it was perfectly legal.

>Did he see that he wouldn't get anything from the SUV lady and tried to go after someone that he could soak a good payout from?
Bingo. He tried a second time, and that was thrown out too. Basically anyone who's name appeared on that police report, he tried to sue. Anything to show he wasn't at fault for speeding.

> Bingo. He tried a second time, and that was thrown out too. Basically anyone who's name appeared on that police report, he tried to sue. Anything to show he wasn't at fault for speeding.

What kind of shit lawyer would take that case? Most lawyers that deal with accidents work on contingency and that's a pretty fucking weak case to take for a contingency

Most amputations no need, the vessels will constrict and you will hardly lose blood, will look very dramatic so people will look after that patient first even though his care can wait (if there are other patients) because it's a C. problem.

That's a thoracotomy, probably the coolest procedure we can do.

oke, I've done a fellowship in the u.s. and the thing that struck me how unstreamlined care was on a national level, it was filled with local guidelines and regulations instead of a nationwide approach.
A lot of countries should look at the Netherlands, their trauma care is probably the best in the world. If I'd ever had to choose for a place to get a multiple trauma injury it would be Amsterdam.

>calmed down the mother and daughter in the SUV

That's very good of you, most passerby's do nothing or too much in their inability. But comforting people is something most people can do.

Higher up.

Most difficult patients are those with multiple problems which all need attention, we do DCS, damage control surgery which means: get them sort of stable in 1-1,5 hours and to the ICU. Then it's just waiting until they get a bit better, but most of the problems are taken care of temporarily or if they are small not even because the risk of initial surgery is higher combined with other injuries.

Seatbelt helps a tremendous amount, without it you either slide against and over the steering wheel or under, both come with their own specific set of injuries. Even the seatbelt itself has a specific set of injuries but it beats hitting your sternum against the wheel and then your face against the glass.

KNOW YOUR ANATOMY, I'm one of those asshole surgeons who will ask you about every little artery.
KNOW YOUR RADIOLOGY, easy to learn, always handy.
KNOW BASIC STUFF, a given.
Be smart, be eager, don't fucking complain, I make more hours then you do anyway, don't try to impress me.
ASK QUESTIONS.
Also the golden move which I used during my residency is to ask things you know but phrase them as a question:
Such as: "Is that the a. lienalis?"
Be prepared for questions back asking what it's for or where it originates from.

>What kind of shit lawyer would take that case?
I remember I had to go to the lawyers office the second time to give my statement on what happened. I had to drive like an hour and a half to get there so he must've gone through MANY lawyers before finding one stupid enough to take him on. After I gave my statement, I heard nothing about it except it was thrown out. That was about 6 years ago now.

> oke, I've done a fellowship in the u.s. and the thing that struck me how unstreamlined care was on a national level, it was filled with local guidelines and regulations instead of a nationwide approach.
A lot of countries should look at the Netherlands, their trauma care is probably the best in the world. If I'd ever had to choose for a place to get a multiple trauma injury it would be Amsterdam.

You're probably correct too, I'm not defending anything we do. I have traveled outside of the USA but I've never done any sort of fellowship so I can only speak anecdotally.

However, I am not impressed by the ambulances I have seen outside of the US and Canada. We carry a lot more equipment. A lot more.

I was just recently in a crash that broke both my legs. My physical therapist cousin told me that my right leg basically exploded (20 cm comminuted) because I had pressed the brake pedal so hard. If I had let go of the pedal right before impact, would I have not been injured so badly?

more info - bilateral tib/fib fracture, very very filthy disgusting open fracture wounds on right side

Unbelievable, if you wanted to you could have gone after him in small claims court to compensate you for the time and the mileage for being there (you can do this very easily but actually obtaining payment is difficulty)

I know what he went through, and though he was a moron, I wasn't going to go after him for being a total moron. More effort than it was worth.

Any of the personal injury law practices that you see advertised on TV would take it. Charge out the ass for their time and on the off chance you DO have a case, they take 80% of the settlement.

>Most amputations no need, the vessels will constrict and you will hardly lose blood

That's fascinating as fuck. The human body is crazy durable when it needs to be.

> 80% of the settlement.

Where do you live? In Florida they take 33.3%

I'm just making up figures. I'm just saying find a REAL practice in the yellow pages or on google. Dont go for so called ambulance chasers.

Q cars or in the US, sleeper cars.

Are these super dangerous or can most frames withstand a crash from a car whose engine is swapped for something stronger.

What would you recommend as the one thing people should do to reduce injury in a crash?

Do you think airbags help at all?

depends on the car. Sleepers like the Ford Taurus SHO, Pontiac Grand Prix GTP, or Buick Regal GS were extremely safe cars for the time

>More equipment =/= better.

People need to know how to handle equipment well to make a difference.

To take the Netherlands as an example again, their ambulances are equipped rather sparse but they are just there to get a patient A&B stable enough to bring them to a lvl 1 trauma centre, they have about 11 lvl 1's in a country smaller then most U.S. states. Amsterdam even has 2.

Combined with a very well equipped Air ambulance which is working together with the London air ambulance (best air ambulance in the world) with an anaesthesiologist onboard who can perform thoracotomies and do RSI nobody dies on the way to the hospital.

And the Trauma centre's are insane, the AMC in Amsterdam has 4 Emergency rooms 40m from the ambulances of which two are fully equipped with a CT scan on rails, they can do a whole body CT scan the moment someone is on the table without moving them.

But then again they do benefit from a geographical advantage.

Straight leg breaks, bendy leg bends. So yeah.

I do have to mention that only is the case with full or near full. if you see it squirting out in bursts apply pressure to the wound, a pressure point or apply tourniquet. But that is a given.

That's more a question for an engineer. Nor do we really have those over here.

You i the UP by any chance? I asked my mom who is an ER nurse about the case and she said it sounded like a case she just had.