first on scene of accident did I do all I could have?

[Robbin M]

Hi,

I am new here and a student nurse. I would like some input to a situation I was in yesterday. I saw a young man get hit by a van as he was running across the street. It was horrible. He flew up into the air and landed on his head.

I was right behind the woman who hit him. I was the first person at the scene. I need someone to tell me I did all I could to help the young man. I checked to see if he was breathing by putting my hand under his nose and mouth. He was so twisted I could not check the way you are supposed to. He seemed to be breathing, it was shallow but he was able to blow blood onto my hand. He was unconscious. I checked for his pulse and it was rapid, but he had a pulse. He had blood pouring out of his nose and ear and I believe his mouth also. Someone came up and asked me if I knew CPR. I told her I did, but he did not need it because he had a pulse and seemed to be breathing. I sat with him and put my hand on his shoulder and told him EMS was on their way. The EMS were there within 2 mins.

There was an enourmous amount of blood under his head. When the EMS got there they rolled him onto his back and placed a plastic tube in his mouth and throat..i do not know what it is called. They did not bag him or start any kind of emergency breathing nor compressions. So I believe he was breathing, just blood in his throat. What do you do if someone stops breathing but has blood pouring, not trickling, out of nose and mouth?

I was calm and did not panic, but I was so scared. Today I just feel weird. Did I do all I could have done? Since the emt's did not start rescue breathing does that mean he did not need it?

[NurseDennie, BSN, RN]

(((((((Robbin)))))))))

You did everything you could do. I know you're feeling scared and shaky now, and probably just a little bit sick. Don't try to second-guess what you did.

He was bleeding from the nose and mouth - you can't apply compression there to stop the bleeding. He was breathing, so you didn't need to do any rescue breathing.

You were right not to move him. If his mouth and nose had filled with blood - then you'd have to logroll him to let the blood roll out so he could breathe.

You turned him over to the EMT's breathing. Sounds like a success story to me.

I also came upon a horrible accident. It's been a couple of years, and I'm still having flashbacks. Don't think you're the only one to think about this horrible thing from time to time and get shaky all over again. I hope the young man does well and I hope somehow you find out that he did well!!

(((((((((((Robbin)))))))))))

Love

Dennie

[2ndCareerRN]

Robbin,

First of all welcome.

Second, I feel you did a fine job considering the circumstances, and your level of training. You assessed the fact he did not need CPR and stayed with him. Just your presence may have helped him remain calm, and helped prevent further injury.

It sounds as though EMS intubated him, you do not always need to assist breathing with an intubated person. I would be willing to say EMS placed the tube to protect the airway (ABC's). Once the tube was in place they would have a patent airway, and could start bagging him if they needed to.

Feeling scared is natural, but the important thing is you stayed calm and did what you could for him.

From what you have said, I believe you did just fine.

bob

[hoolahan, ASN, RN]

Without suction, there is really nothing you can do. If he landed on his head, and had blood coming from nose, mouth, and ears, he probably had a serious skull fracture.

I once was on the scene of a drowning, a 7 yr old pulled from the water, and I couldn't understand why the lifeguards didn't start mouth to mouth, until I stepped over to try, opened his mouth, nothing but water and food, quick-thinking lifeguard?EMT turned him on the side and did heimlich, while he was on his side, so everything drained out, we had to repeat this manuever several more times, b/c everything we tried to open his airway, more of the same. He was w/o O2 for a significant time, and once we cleared him enough to try to bag, we had to use a jaw thrust, and force air in. I was doing compressionas at first, and I could feel the gurgling in his chest as air was trying to go through so much water. I will never forget it. He had been submerged for a good while, he was dark-skinned and the water was cedar water, so he wasn't spotted right away. When ACLS got there, and tubed him, they said his voacl cords and epiglottis were very swollen, no wonder we had such a hard time ventilating.

Honestly, in your situation, you wouldn't have been able to even do mouth to mouth, his airway would become blocked with the blood and form clots. If he weren't filled with blood in his mouth, there may be no other choice than to turn him over and do CPR if not breathing. If you couldn't ventilate, maybe just do compressions.

You did the right thing. You do not have the training to move him, most nurses don't. He was breathing, and had a pulse. The best thing you could do is stay with him so he isn't alone, or move him to a safe area if he is in danger of being hit again.

How sad for you to have had to see this. It is very very sad when something like this happens. {{{{{{{Robin}}}}}}}}

[Robbin M]

thanks for responding. I needed to hear that I did all I could. I got home and just started second guessing myself.

I am having flashbacks. It seems life is so delicate. He was alive and waving to the car that stopped for him, and then he was on the ground bleeding. I still can't believe it. If he had stopped to look for one second it would have turned out differently.

thank you.

[Robbin M]

hoolahan, thank you for your support. Everybody at the scene believed me, no one else checked to make sure ...they just trusted me!!! that is why I second guessed myself. I was glad the EMS got there within minutes!

[WashYaHands]

I agree that you did everything right. Your calm presence most likely helped him to remain calm too. About a month ago, I witnessed 2 teens on a bike get hit by a truck. I stopped to help and called 911, they were breathing (screaming, actually) so I tried to calm them and keep them still until the paramedics arrived. I know what you're going through with the after shock of it all. I still have flashbacks when I cross that intersection.

Linda

[Nycole]

Robbin,

Sounds like you did all you could do, even though it may not feel like much. Sometimes there is not a whole lot you can do, especially when you don't have any equipment with you. I'm an EMT and I am suprised that no one took time out and talked to you (EMTS, Police, etc) to find out what happened and double checked to make sure you are ok emotionally. That is one of my concerns, after we take care of the patient (husband has a heart attack, the wife witnesses it) I try to make sure any family members present are ok.

Sounds like your guy had sustained a pretty nasty head fracture. But if he was breating, he was breathing. Best off not moving him due to compromising C-spine. If you had suction, you could of cleared the airway (but who carries suction with them) and if you had a pocket mask or bag valve mask you could of assisted his ventilations if they were slow and shallow. But again, that is equipment you usually don't carry in your back pocket.

Even as an EMT, I am fine in an ambulance with my equipment nearby, but first responding to a scene is always a little nerve racking. You don't have your equipment, and in something critical such as this, it always feels you could of did more, eventhough there was nothing for you to do. Good job not moving him though - very important.

Nycole

[oramar]

You showed remarkable composure and presense of mind. When I was a new nurse and a student I was involved in something like this. I second guessed myself like crazy. Years later when I was much more experienced I looked back in amazement at how well I did.

[Robbin M]

this man died last night. I just found out. I am so sorry his life ended that way.

[Love-A-Nurse]

originally posted by robbin m

this man died last night. i just found out. i am so sorry his life ended that way.

robbin, i am sorry to hear of his passing. know that you did all you could and i am sure the others did too. my hat is off to you for stopping and doing what you could do.

[lv2ski]

Robbin, You did a great job and service to this victim by assessing the abc's and being there to provide comfort. There was nothing else you could do, as many of the other members have said, without suction and an airway,etc....

I must admit this is one of my fears in life (besides snakes and flying), of being a witness of a horrible trauma situation. I have always hated car accidents since being a child. But I know I will have to put my personal fears aside somehow and try to put my training forth should I need to, just as you have done so well.

Best of luck

LR, med-surg RN