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Another Moto Accident


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#1 nauticab

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Posted 22 February 2012 - 11:00 PM

corner of 2nte and 15. 2 motos vs a chevy car. 1 moto was a tourist here on vacation with his family, staying at a southern hotel. from what i understand, it was not his nor the other moto's fault. i did not see the other driver of the other moto, but the one i saw badly split his lip, scraped his whole face, knee, arm and shoulder. he was wearing his helmet but it flew off of him after the crash. lost consciousness for a few seconds and they were trying to get him to sit down, totally disoriented. i was driving by seconds after the accident but did not see it happen. other than the obvious of "please don't rent a moto", here are some other suggestions for drivers and passersby...

1. if you insist on renting a moto, MAKE SURE THE HELMET FITS AND IS ON PROPERLY. the chin strap should be 2 finger snug, like a dog collar. any looser and the impact of the crash will make it fly off and you will be stumbling on the street from a major concussion.
2. i stopped to help with translation and an off duty paramedic was also there. if you speak both languages, this is an invaluable service.
3. GET ICE IMMEDIATELY! there was a restaurant right there with 30 people standing around and NO ONE asked for ice! this is basic first aid people. and the lady at the restaurant, watching this, took her own sweet time to get it. ARG! apply ice immediately on the banged or bleeding spot and the victim will be forever greatful.
4. once the paramedics and ambulance arrive, ask if you are needed for any translation help and if not, leave. no need to hang around.

this family was on the 4th day with 3 left to go. the guy should be ok but he will return with a very bruised face and probably a few stitches in his mouth. oh and a large moto bill for repairs.
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#2 CZMDM

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Posted 23 February 2012 - 06:58 AM

Keep in mind that there are no "Good Samaritan" laws here. If you help someone lying in the street and you touch them you could be sued later for damages. You can talk to them and basically ask where it hurts, but if you touch them you could have problems. I have taken both first aid and CPR courses here on the island and this issue was stressed in both classes. This is why when you see a wreck, all of the witnesses are standing in a cirlce around the victim and nobody is helping them (usually).

I saw two wrecks withing the last two weeks less than 100 feet from our villa. The second was right in front of our gate. A bus had run the stop sign on 14 and hit a moped going South on 15 Ave. The second wreck was a mess. I don't know if the guy made it.
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#3 morenita

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Posted 23 February 2012 - 12:36 PM

OMG. PLEASE DO NOT give first aid advice if you are not a trained professional. In the case of a trauma victim, internal bleeding can cause hypothermia even in warm climate due to a decrease in supply of oxygen. The decrease of oxygen lowers the body temperature. This results in blood not sufficiently clotting, creating a deadly cycle, also known as the trauma triad of death. Ice is to be applied in the case of tissue damage but in the case of blunt force trauma it could make matters worse further putting someone into shock and could kill the person. The proper treatment for severe trauma with circulatory shock is to keep the victim warm and calm. Anxiety increases breathing thus requiring more oxygen. First call for an ambulance, immobolize and do not move unless it is absolutely necessary (as in by remaining where they are could further endanger their life, like if they were trapped in a burning car). If you notice severe life threatening arterial bleeding than pressure should be applied. But in most of these situations it is best to call for emergency service first and foremost, immobolize and then to keep them calm, warm and do not move.
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#4 crunch

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Posted 23 February 2012 - 02:12 PM

The only things you should do is immobilize their neck and tell them not to move (hands on the sides of the head)

If hemorrhaging apply pressure

If not breathing/heart not beating then do CPR - you can't hurt them at that point as they are already dead.

Then let the paramedics take over when they arrive

Also, do not help if you will endanger yourself because of an unsafe scene
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#5 MarkC

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Posted 23 February 2012 - 02:44 PM

Then after helping the victim, ask if there's a lawyer in da house, boyyyyy..... lol
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#6 morenita

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Posted 23 February 2012 - 04:34 PM

Well said Crunch. I was only commenting on the advise to apply ice to a trauma victim when there is a possibility of internal bleeding (haemorrhaging). I have seen hypothermia, not hyperthermia, but hypothermia in very hot conditions. It can happen when there is interior bleeding. I have seen in a publication a body temp of 32 degrees ( 90 F.) in 38 degree weather ( approx 100 F. ) due to haemorrhaging caused by blunt force trauma and the victim died. I have never heard it suggested to apply ice to a trauma victim as a form of basic first aid. You could make the ciculatory shock even worse and kill them. There are studies and published articles where in controled situations cooling a victim might have positive affects. But this is not first aid to be practiced by the average bystander in this type of situation. There was a study I read about for the use of therapuetic hypothermia for brain injuries as well as applying ice in certain trauma situations but this is by trained professinals. Ice is recommended for cauliflower ear and eye injuries and etc. But not when there is severe trauma with possible interior bleeding and ciculatory shock. But these circumstances need to be decided by professionals. For the average passer-by it is not appropraite. Keep them calm, warm and comfortable. Cold and anti inflamation drugs are for tissue damage as it reduces swelling but to suggest applying ice in a situation like this is insanity. My advise to the passer-by with minimal first aid knowledge. Call for an ambulance, keep them warm, calm and do not move them. Yes keep them immobile. Apply pressure to arterial bleeding when it is life threatening and of course CPR if there is no pulse or breathing because as Crunch said at this point they are dead and reviving them is the most important thing. But in this circumstance it was obvious that the person was conscious and there was no mention of severe bleeding. So it should be treated as a trauma situation. The person could be in shock due to internal bleeding and not showing any normal signs. Individuals on beta blockers may show a normal blood pressure and no increase in heart rate. The person could be in shock ( it was mentioned that he was disoriented) and you or they would not know it. Keep them warm, immobile, calm and wait for the ambulance but definitely do not apply ice in a serious accident. This could make any possible hypothermia much worse, which would prevent the blood from clotting and lead to metabolic acidosis, causing death. A little swelling and bruising is preferable to dying.
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#7 nauticab

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Posted 24 February 2012 - 12:37 PM

just an FYI, after he got his wits together (we are talking about 2 minutes post accident) he was answering us as to his name, where he was, how long he was here, where he is staying, who he was with etc etc. his first minute or so after the accident is when he was disoriented and the people living there had to force him to sit down and be calm. then i got there. he was sitting up and was lucid. it was not a serious accident, prob a mild concussion and a badly busted lip. if there were continued signs of unconsciousness, dizziness, serious trauma symptoms, then of course, just keep him warm and calm.
i have had lots of first aid training and ice was needed for his lip. an off duty paramedic was with me when i got there to help with translation. ambulance was already called. as soon as they got there, we gave them a briefing of what was told to us and had them take over.
ice in this case, was proper, as noted and continued by the ambulance when they arrived.
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#8 crunch

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Posted 24 February 2012 - 01:46 PM

I think you did great. I am a nurse, but those guidelines I posted were from 1st aid (out of hospital) classes I took long ago. And i a,ways follow them because I know that way I can do no harm until the paramedics get there. And the ice to the lip was a great idea.
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#9 morenita

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Posted 24 February 2012 - 07:13 PM

I am not trying to make this personal or to get into a bragging contest of who has had some first aid training as opposed to a couple years of med school. I am saying that what you suggested is WRONG. You were suggesting that if someone comes across a motorcycle accident to "apply ice immediately", your words not mine. You are very mistaken and this is very bad advice and could kill someone. Hypothermia is a common occurence with severe trauma. With circulatory shock you have a very deadly cycle of hypothermia, coagulopathy and metabolic acidosis when the cells burn glucose raising the acidity of the blood. This can most certainly lead to death. You should never suggest to the common by-stander to apply ice in a situation like this.

I have seen trauma in a victim that appeared as you say "lucid" and coherent and not showing "serious trauma symptoms". You can be in circulatory shock with haemorrhaging without any of the normal symptoms. In the case of intra abdominal bleeding there may be very little indication that anything is wrong. Sometimes the only sign may be weakness. The signs can be progressive. With certain medication, such as beta-blockers, even with the appropriate medical equipment for checking there may not be the normal signs, like increased heart beat. You mentioned there were no signs but there is no mention of rate of breathing. Or if he was thirsty. No mention of heart rate or decompensation. No mention of skin condition due to vasoconstriction or any of the other various signs of circulatory shock or severe trauma. You should never suggest to the passer-by to immediately apply ice in a potential trauma situation. Unless you can tell me, and can recognize, ALL the possible signs of someone who is in circulatory shock and can identify possible interior bleeding in any and all situations then PLEASE refrain from suggesting what you did. This is wrong and irresponsible.

A person CAN have haemorrhaging with all the symptoms you explained. And the average passer-by is not going to be able to determine whether or not there is interior bleeding. There are numerous occassions of someone who has had what appeared to be a very minor accident, with no signs of shock, appeared to be perfectly fine to the average observer and many hours later died. Applying ice can further complicate a case of hypothermia. And your suggestion to the average person is wrong and you should retract it so that no one gets the wrong idea.

I have read many things on these boards and even though I knew it to be wrong I did not say anything because it was not life threatening. I don't like to get involved in controversy or meaningless arguements. I usually just let them talk and they will eventually show how little they really know about the topic they are discussing. For example I have seen individuals suggest that for a jelly fish sting you can apply alcohol, hydrogen peroxide, ammonia or even urine. This is WRONG and I knew this to be wrong ( this can actually release more toxin) but did not say anything because it was not life threatening, but what you have suggested could actually kill someone. This is wrong and irresponsible.

You did not say in the first post to simply put some ice on a split lip you said to "apply ice immediately on the banged or bleeding spot". This could be understood that if there was an area of severe bruising or haematoma in a potential case of trauma that the first thing to do is to apply ice. You should correct this and never again suggest such a thing. If you had explained the entire situation and said that you applied ice to a split lip and that you were "only" suggesting putting ice on a bleeding lip and not to treat the bruising or injured shoulder,arm, and leg with ice than I would not have taken issue, but you said "apply ice immediately on the banged or bleeding spot" "this is basic first aid people" It is not and you are wrong to say that it is. You were implying that it is basic first aid in a potential trauma situation to apply ice to the "banged spot". Ice should be applied when you are certain you are only dealing with tissue damage but not in the event of an auto accident which is the majority of all cases of severe trauma followed by falling. Such haematoma can be indicative of more severe internal damage in a trauma case. It is is wrong to suggest use of ice in a case of possible trauma for all of the reasons I have mentioned.

Please correct this and not double down on error. It is wrong to suggest for someone happening by a motorcycle accident to apply ice immediately to the banged spot. Especially when you have no idea of the person reading your post has any first aid training at all. Your suggestion is as I have said, irresponsible.

Providing translation was a very good thing, your suggestion regarding helmets is very good and after a further detailed explanation the application of ice to the lip is Ok. But I fear people reading this will take you seriously. And you could have someone with no first aid training witness a motorcycle accident and start running to a nearby restaurant and applying ice to a trauma victim with circularory shock. This could potentially cause someones death. The advice to apply ice to the "banged spot" involving an auto/moto accident remains to be incorrect, and needs to be corrected. Please for the sake of any future accident victim.
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#10 morenita

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Posted 24 February 2012 - 08:23 PM

I sincerely appologize for the comment about what the intention might be for posting what you did. It was innapropriate and I am sorry. But I was offended by the FYI remark, like I do not know what I am talking about. I DO and you could learn something from it.
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#11 Tomas

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Posted 24 February 2012 - 08:33 PM

Well, don't rent a moto, that's been an ongoing mantra on the board here for a while. I've had a lot of first aid courses and I teach them too, along with scuba. I tell my students that the most important first step in helping someone is to get the phone out and call for help. It's hard to say what should have been done in the double moto car incident that started this whole thing because we weren't there. Mike brought up some good points on the good samaritan laws, and just like any law in any country you're going to live in or spend some time in, you ought to have some familiarity with them. Some of us might jump in and help regardless of the law and some won't. It is what it is...
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#12 morenita

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Posted 24 February 2012 - 09:07 PM

I never said anyone did anything wrong in this situation because you are right I was not there. I did say that it is wrong to be suggesting that the next time someone else comes across a moto/auto accident that the thing to do is to "GET ICE IMMEDIATELY!" "apply ice immediately" because "this is basic first aid people" It is NOT and this is WRONG. After further explanation I do not have a problem that ice was applied to the lip. I take exception with the implication that it is correct first aid to appply ice in a trauma situation as if this should be standard procedure. This is incorrect. Show me one recently published text book on blunt force trauma that would suggest this treatment in the event of a moto/car accident with possible circulatory shock and internal bleeding. And by the way the majority of blunt force trauma victims are from auto accidents and falls.

I copied this entire thread and emailed it to my professor. I just wanted to make sure I am not crazy and not giving bad information. My concern, and so was his, was how someone with no first aid training reading this, might interpret it. What would they think if they came upon a auto/motorcycle accident with the victim having damage to face, shoulder arm and knee or basically one whole side of the body and had been unconscious and disoriented. Would they think (when there is the potential for severe trauma from a collision with a car) that to "immediately apply ice" to the injured area would be the correct thing to do. And that this is really "basic first aid people". Well it is not and they should not. And they would be WRONG to do so. He was in total agreement with me and his final comment was and I quote "You are 100 percent correct. I do not know what kind of books this man is reading. You explained it well. You know what you are talking about". I am not saying this to try to seem important. I just do not want wrong information to be given which could harm another person. This is a serious matter concerning life and death. Egos should not be relevant here. I never have a problem admitting when I am wrong. This is not about me or the other poster. I am not a doctor, or any exceptional person. Just an average person who is passing along what I have been taught. This is not my opinion. I did not create any of the science. This is just basic first year med school for blunt force trauma and circulatory shock. I am not trying to start anything. I would just hate to see someone severely harmed because some bystander thought this was correct first aid treatment in a trauma situation.

Regarding intervening in a situation like this, I personally would not let possible harm to myself stop me from helping someone else or worry about if I could be sued for aiding someone. But that is just me. I realize not everyone would agree with me. And that is their decision.

And please to anyone reading this if you happen upon a motorcycle accident, for the love of God, DO NOT run to the nearest restaurant for ice and "immediately apply" it to the victim.
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#13 morenita

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Posted 25 February 2012 - 01:02 PM

This article was sent to me by my professor in the Emergency Medicine Education Dept. and written for the New England Journal of Medicine

Traumatic injury is the third leading cause of death for all age groups in the United States and the leading cause of death for those under age 44 years.

More Americans under the age of 34 years die from unintentional injury than from all other diseases combined. More than half of all deaths occur before the patient reaches the hospital. About three-fourths of the patients who arrive at the hospital will die within the first four hours. About one-fourth of those have survivable injuries but quickly succumb due to complications.

One of those complications is hypothermia, occurring in about 10% of patients.

Non-trauma related mild hypothermia, defined as a body core temperature between 32 degrees Celsius and 35 degrees Celsius, is generally well tolerated. Researchers found a 21% mortality rate in patients with a core temperature less than 32° C originating from environmental exposure. However, that same degree of hypothermia following traumatic injury resulted in 100% mortality, independent of the presence of shock, injury severity score, or fluid resuscitation.

Both civilian and military patients suffering traumatic injury have significantly increased mortality if they arrive at the hospital with lowered body temperatures compared to normal. Unintentional hypothermia occurring in the prehospital environment is associated with a three-fold mortality increase in isolated, blunt, moderate to severe traumatic brain injury, even when transport times are short.

Prehospital researchers in Pennsylvania analyzing a state-wide trauma database found a similar mortality association for all hypothermic trauma patients over the age of 16. A 12-year retrospective review of burn patients in New York State found that hypothermia was more common in patients with large body-surface burns and was associated with higher mortality.

Intentional versus unintentional hypothermia
One important distinction that EMS providers must make is the difference between intentional and unintentional hypothermia. Clinicians induce hypothermia under controlled and monitored conditions for the purpose of protecting the brain from ischemic harm. Intentional hypothermia appears beneficial in a select subset of traumatic brain injury patients and during the post-cardiac arrest period. Animal studies suggest the theoretical benefits to humans likely arise from altering the inflammatory response to ischemia, decreasing oxygen consumption in the brain, and reducing free radical formation in ischemic tissue.

Unintentional hypothermia following traumatic injury, on the other hand, represents a failure of the body’s compensatory mechanisms for thermoregulation. The body responds to heat loss by shivering, which increases oxygen consumption in skeletal muscles by 40% to 400%. This high metabolic demand places some organs at risk of developing ischemia. By the time hypothermia develops, the energy reserves of the body are depleted and the system is showing signs of exhaustion. Hypothermia interferes with the clotting mechanisms of the blood by disrupting platelet function, slowing the chemical reactions that ultimately produce the protein strands necessary to build blood clots and by suppressing the immune system. A drop in body temperature of 1 degree Celsius results in a 6% to 7% decrease in cerebral blood flow, which could be dangerous for patients with traumatic brain injury.

Content Description
Trauma patients with multisystem injuries pose unique
challenges for trauma nurses. Perhaps one of the
most complex challenges relates to hemorrhage and
the associated triad of acidosis, coagulopathy, and
hypothermia, also known as the trauma triad of death.
Critical care and emergency nurses must understand
the concepts involved in this triad as they directly affect
traumatic resuscitation practices. The pathophysiology
and treatment modalities for acidosis, coagulopathy, and
hypothermia will be addressed. The symbiotic nature of
the triad will be stressed. Early recognition of patients at
risk for the trauma triad will be emphasized. This session
is for any critical care or emergency nurse who cares for
injured persons. The participants in this session should
have a basic understanding of hemorrhagic shock. An
outcome for the participant is knowledge of the triad,
thereby leading to early recognition, improved care and
hence decreased mortality for injured persons.

I thought I could attatch this entire symposium but I could not.
It is extremely interesting.

Hypothermia developed in 57% of trauma patients according to a recent study. And more severe with injuries to the abdomen, pelvis and extremities. This is typical with motorcycle accidents due to impact with the pavement. And with intra abdominal injuries the signs can be much less apparent. The victim can appear to be perfectly fine but slightly weak. Again they stress in these situations to allways treat as a severe trauma victim. As long as the person is conscious and breathing and no life threatenig arterial bleeding to keep the victim immobile, warm, comfortable and calm. And wait for paramedics to arrive.

Mortality rates in trauma patient with an ISS<25:
◦Core temp <32⁰C (89.6⁰F) :100%
◦Core temp 32.1-33⁰C (89.8-91.6⁰F): 69%
◦Core temp 33.1-34⁰C (91.6-93.2⁰F): 40%
◦Core temp >34⁰C (93.2⁰F): 7%
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#14 artgirl

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Posted 25 February 2012 - 04:22 PM

I'm all for solid information on these forums being dispensed and if a wrong bit needs correction then it's perfectly appropriate to point it out, especially in a medical case, but good grief, I think we are all perfectly clear now that one should NEVER EVER apply ice to an impact injury. I think enough proof has been presented here and Nauticab has suffiently been corrected by now.
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#15 morenita

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Posted 25 February 2012 - 04:40 PM

You do not have to read if you do not want to. I am sorry if this bothers you. And I am truly sorry if this bothers anyone else here and "pobrecita" Carey the moderator. And I am sorry if I seem emotional or passsionate about this. But this is my life and the profession I am studying for. And I take saving life very seriously. If that bothers you so be it. I do not want to see misinformation that could lead to loss of a life. When it comes to trivial matters I rarely comment, except to pass on any pertenant information. But this was different to me. This was a matter of life or death and something I take very seriously. Imagine if their was a child on a moto involved in an accident and someone read this and ran for ice and applied it to the infant. This could cause death. If you do not want to read any of this than don't. That is your choice to ignore it if you please. No one is ever forced to read any thread. I ignore many that are of no interest to me. But this one concerned me alot. If anyone can prove me wrong I would have no problem admitting it. But my professor is one of the leading researchers in EE.UU. on the trauma triad of death. And he has confirmed that what I have been saying is correct. So I feel quite confident in that I am not wrong.
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#16 artgirl

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Posted 25 February 2012 - 04:57 PM

As I said, you have more than suffiently made your points several posts ago and wrong medical information is definately something that needs correction and you brought that to light as well. Don't take things so personally. It's perfectly fine for me to make my opinion known that I believe you are getting very carried away. So, thank you for your apologies in your last post and I won't be reading or posting any more comments on this topic again as the horse died long ago from the repeated verbal beatings.
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#17 Spencer

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Posted 25 February 2012 - 05:22 PM

Morenita..Just a boost ;)

IMHO, keep posting as much as you like....any info that may save or injure a life...they certainly were not verbal beatings, it is all very helpful info. Noone should ever be offended when you are trying to assist in prolonging life. I could never do what you do and not many could do it with such passion and care. Without guidance such as yours in the world, I hate to think of where we would be. I truly believe just by reading your posts you are not trying to berate, only to inform. Which in your profession is extremley valuable to outsiders like me. There has been much more misinformation given on other benign topics on this forum, but this is the most important of all!

If I am ever in a medically needed condition I would hope it was you or someone who read your posts that shows up to assist. Thanks
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#18 morenita

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Posted 25 February 2012 - 05:28 PM

Mil gracias y que Dios te bendiga. And I may be "getting very carried away" but Spanish is my first language. While my english is far from perfect I believe it is pretty good. But I do allways have to think and analize every word I say and constantly edit. So I am sure I get repetative. But my heart is in the right place. But thanks again Spencer. Thank you very much. I am not a Doctor and there are so many people who know so much more than me. But, God willing, I am commited to being the very best doctor. And artgirl just so you know I did not say "NEVER EVER apply ice to an impact injury". I have applied ice in many situations involving haematoma. It is the very best thing to do in the case of a contusion or tissue damage just not in a situation like this where there is a possibility of severe trauma. In the case of severe trauma it is very important to keep them warm and maintain their core temp. Thought I should make that very clear. Ice is a great remedy in many situations and even for a split lip. Much of what was in the first post was right on. Providing translation was great, talking to the victim to check for signs of confusion and concussion are great, keeping them calm and talkative in that way is great. The suggestion about helmets is great. And after fully explaining the situation, applying ice to the split lip after the paramedics arrive was great.
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#19 nauticab

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Posted 25 February 2012 - 05:55 PM

thank you artgirl, you took the words out of my mouth. geez, point taken.
so, for those who have no knowledge of first aid, on the streets or in the woods, and do not know the signs of possible blunt force trauma, please do not apply ice immediately to a swelling injury.
instead, call for help, if you absolutely know what you are doing, do it, and pray to god that someone at least tries to help you in the off chance you get in the same situation and doesn't just stand there doing nothing.

sometimes i assume that others can tell the difference between a minor injury and something that needs more evaluation.
not sure why you were offended by my FYI statement, it was simply to clarify the situation i was in to the thread. and thank you for apologizing about your comment about patting myself on the back. THAT was offensive.
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#20 morenita

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Posted 25 February 2012 - 06:11 PM

I agree it was wrong and I said that it was wrong. I appologized for it and allready edited it out. I thought the FYI comment was suggesting that I did not know what I was talking about. Sorry for that. I would only add that your most recent post is very good. And I would also add that anyone witnessing an accident or passing by can and should try to help and not "just stand there doing nothing" as you said. In this situation they can keep the person warm and can tell them not to move and first and foremost they can call for emergency service. And they can do exactly what you did which was excellent. Talk to the person to keep them alert and from drifting into unconsciousness. This type of conversation keeps their mind on other things and helps keep them calm. Shock can be progressive due to positive feedback so keeping a person calm is extremely important. And talking to them about something else other than the accident is very helpfull. Thats what you did and that was great. Keep them thinking of positive things. That is excellent. What you did was excellent. Providing translation if you are able, and apparently you were, is also very beneficial to paramedics. And that also was really great. And after explaining the situation better applying ice to a split lip was a good thing. So cudos to all that! Basically to recommend doing pretty much everything you did. All this was right on. Like I said I had only taken issue with what sounded like a recomendation to apply ice to the entire side of the body which was injured when severe trauma could be involved and that this is a matter of urgency. Espescially when there was a mention that he had "lost consciousness" and was "totally disoriented". That was the only thing in your original post that got my attention. It was just that one sentence. Everything else was right on, and I applaud you for it.
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