The Prehospitalist

The Prehospitalist Contact information, map and directions, contact form, opening hours, services, ratings, photos, videos and announcements from The Prehospitalist, Medical and health, Williamsburg, VA.
(5)

🚁 Critical care flight paramedic & prehospital educator (MS, FP-C)
🚑 Prehospital pearls & tidbits
⚠️ Not a replacement for protocols, formal education
🗣️ Conversations primarily monitored on IG .prehospitalist

08/03/2026

Excellent example of hemorrhage control from Gabriel Carvalho. He and his partner from the Military Police of Paraná treated a cyclist involved in an MVC with heavy neck bleeding. Wound packing + pressure dressing (with care taken to not occlude airway or apply circumferential pressure) ftw 🙌🏻

Bodies are wild. Thanks to the follower who dropped this case in my DMs.
08/01/2026

Bodies are wild. Thanks to the follower who dropped this case in my DMs.

I don’t literally mean ✨nothing✨- keep reading.“My patient is in hemorrhagic shock and we don’t carry blood, what do I d...
07/31/2026

I don’t literally mean ✨nothing✨- keep reading.

“My patient is in hemorrhagic shock and we don’t carry blood, what do I do?” This question comes up frequently, rightfully so. Often there are responses like “fluids and pressors are all we can do.”

While these situations certainly aren’t black and white, and there is a time and place for responsible use of both interventions, they are sometimes used to “feel like we’re doing something” rather than for the benefit of the patient. Doing “nothing” for a critically ill patient can be hard to stomach.

But what hemorrhagic shock patients need, truly, is blood products and an OR. These are the fixes.

In the meantime, we should be stopping any external hemorrhage. Even when internal bleeding is the major malfunction, moderate external bleeds can add up.

Keep them warm. (It matters).

Manage oxygenation and ventilation. (Don’t kill them with RSI when BP is 💩/☠️).

Assess for other causes of shock.

Consider TXA.

And skedaddle to the closest most appropriate trauma center. No lolligagging. No fu***ng around on scene with non-life-saving tasks (IVs, TXA, etc.). G**o.

Crystalloids (this includes LR) may fill the tank and make the number look better, but they don’t actually aid in perfusion given their lack of ability to carry O2.

Vasopressors may squeeze the tank and make the number look better, but…see above.

Minimal crystalloids are generally acceptable (most of us could probably benefit from a 500 mL bolus at baseline), and vasopressors are indicated when the patient is circling the drain and there’s no other option. But using these interventions aggressively to calm our own need to “do something” is not in the patient’s best interest.

(I recognize there is some theoretical benefit + limited data supporting the use of vasopressin or norepi in early hemorrhagic shock. More research needed - but the basics are still the basics).

There will never be one right answer in these situations. The best we can do is understand the physiology, recognize what the patient needs to survive, perform the basics well, and get them to definitive care as quickly as possible.

Leave your thoughts👇🏻

30s y/o male falls approximately 20 feet off a ladder without LOC and is unable to get himself up. Upon EMS arrival, pat...
07/31/2026

30s y/o male falls approximately 20 feet off a ladder without LOC and is unable to get himself up. Upon EMS arrival, patient complaining of leg numbness and weakness. SBP in the 70s. HEMS requested for potential spinal cord injury.

Upon HEMS arrival, patient AAOx4 with full memory of mechanical fall. Further neuro assessment reveals no sensation distal to epigastric region. Minimal toe movement only in lower extremities. Upper extremities mobile but weak with numbness in hands.

SBP continues to be 70-80 despite 500 mL NS bolus. HR remains ~60. Skin warm and dry. SpO2 adequate, patient denies shortness of breath. No obvious external injuries. No neck pain. Pain unable to be assessed distal to chest due to loss of sensation.

Primary impression: neurogenic shock. Due to potential for multisystem trauma and inability to rule out internal bleeding, hypotension treated with whole blood (+2g TXA). FAST negative during flight.

ED scans confirm cervical injury.

Key takeaways:

👉🏻Neurogenic shock appears as an uncompensated shock due to unopposed parasympathetic stimulation: hypotension without ability to raise HR or vasoconstrict (low-normal HR, warm skin)

👉🏻Typically occurs due to injury at C or high-T level

👉🏻Neuro deficits (paralysis, weakness, paresthesias) may be complete or partial in extremities; upper deficits not always = to lower deficits depending on injury type

👉🏻Deficits may reach maximum initially or worsen over time (continuing assessments should be performed)

👉🏻Ventilation should be monitored closely in case of loss of respiratory drive due to paralysis (severe cases may require NIV or intubation)

👉🏻**Hypotensive multisystem trauma patients are bleeding until proven otherwise**. Symptoms may match neurogenic shock completely - they can still also be bleeding (without compensatory tachycardia and skin signs due to SCI).

👉🏻Negative FAST ≠ no internal bleeding (especially in cases of retroperitoneal bleeds)

Leave your experiences with neurogenic shock and SCI👇🏻

(Potentially-identifying case details modified or omitted)

📷: ddxof.com

Every time I share these (amazing) texts I get a load of questions. So I decided to hit up our peer support manager who ...
07/29/2026

Every time I share these (amazing) texts I get a load of questions. So I decided to hit up our peer support manager who was happy to chat. (Thanks Dave!)

07/29/2026

Salt Lake City Police Department shared this incredible video with permission of the family. This call was reported as an assault involving an elderly woman, but responding officers quickly realized it was an autistic child in crisis. The use of the sensory kit to help calm him was *chef’s kiss* 🤌🏻 “We’re not tantrum anymore” and “I like that bag” were beautiful to hear. Big thanks to the family for allowing PD to share this video as an example of how these (common) situations should be handled.

It’s the same concepts each time, tailored to the situation and family’s needs. Hone the skillset and deliver it with co...
07/28/2026

It’s the same concepts each time, tailored to the situation and family’s needs. Hone the skillset and deliver it with compassion and care.

Female in her 40s presents to ER via EMS with appropriately-placed TQ for deep, gaping laceration to antecubital arm. De...
07/26/2026

Female in her 40s presents to ER via EMS with appropriately-placed TQ for deep, gaping laceration to antecubital arm. Decreased LOC from PTA blood loss, blood products given. Several TQ takedown attempts made in ER without success.

Upon HEMS arrival, patient alert but pale & diaphoretic, complaining of severe pain from TQ. HR in 60s, MAPs 70s-80s. Fentanyl given with minimal relief.

TQ left in place while pressure dressing removed for wound inspection. Non-hemostatic wound packing noted to be saturated; removed + replaced with Celox, new pressure dressing placed. TQ left in place to give Celox time to work & avoid massive hemorrhage during movement to aircraft.

Upon settling in aircraft, TQ slowly released with no signs of rebleeding. TQ left loosely in place for rapid re-deployment if needed, with ready access to a new TQ in case of failure from previous use.

Patient showed immediate signs of relief. Skin returned to pink & dry. HR increased to 80s, MAPs remained adequate. No further intervention by HEMS needed.

✅ Key takeaways:

Pain is better than bleeding to death. If responsible takedown is not possible due to contraindications (see below), lack of training, equipment, or hands, it should not be attempted.

But, TQs are profoundly painful; if the situation allows for responsible takedown, we should do so - especially with the prevalence of placement by lay people for less acute injuries.

Adequate wound packing + pressure, especially with hemostatic gauze, can control major bleeds, even those that appropriately received a TQ at initial contact.

Wound should be adequately packed & dressed as indicated *prior* to TQ release.

TQ should remain ready for immediate redeployment. Constantly reassess.

This patient was in profound pain but showed a decrease in HR due to presumed vagal response (pallor, diaphoresis). Vitals do not reliably measure pain.

🛑 General contraindications:

Traumatic amputation with TQ placed immediately above stump

Decompensated shock or other life-threatening injuries

Inability to closely monitor for rebleeding

Leave your experiences👇🏻

📚PMID: 33303278
📷: Ben Kam MD, Wheeless’ Textbook of Orthopaedics

07/23/2026

This cardiac arrest shared by Josh Cobb happened just over 2 years ago with a life saved by excellent BLS. These guys recognized the arrest (note the patient’s color and agonal respirations) and deployed the two most important tools: early AED use and good CPR. Anyone can do it - are you prepared?

Incredible work 👏🏻

Timely that I went to the grocery store in the middle of compiling this with my shorts on backwards as a whole ass adult...
07/22/2026

Timely that I went to the grocery store in the middle of compiling this with my shorts on backwards as a whole ass adult. Anywho, a small reminder that we’re all human. #13 is mine, the rest are yours. What else?👇🏻

Address

Williamsburg, VA
23185-23188

Website

Alerts

Be the first to know and let us send you an email when The Prehospitalist posts news and promotions. Your email address will not be used for any other purpose, and you can unsubscribe at any time.

Shortcuts

Share

Category