Leaderboard

Well, it's beginning to sound like maybe she should have got a CT last night. It sounds like the family has a pretty good explanation for the fall, it's probably a simple trip and fall. This may be partly a result of all the infirmities of age, a prior ortho' injury, and possibly a bit of Parkinson's developing ("shuffling gate"). I think for confounders, any suspicion of elder abuse? Any recent med changes? Any suspicion of sepsis? While we may have other more pressing issues to deal with, it would be nice to point out to the ER if there are any issues in the home to be aware of, e.g. other trip hazards, need for handrails, walking aids, home care, etc. This is beginning to have the smell of a one-way trip. Unfortunately, I think even with this good history, we have to c-spine her. If she was 40 years old with this history I wouldn't. This is going to increase her ICP, decrease her respiratory reserve, increase her risk of aspiration, and make intubation more difficult. But, I can't see the ER being too happy if I don't. ITLS would make this a critical trauma, and we'd be tearing out of there like it's the end of the world. Reality, this has developed over night. Let's get an IV, bG and a set of vitals, and run a 3-lead, and make a decision about where we're going. The 12-lead can probably get done during transport, or as it takes all of two minutes, on scene. I'd pull some blood for an iSTAT en route. It seems unlikely that she's hypoglycemic (although she is old and beta-blocked, which could mask some symptomology) or that this is some sort of atypical seizure activity, but those possibilities should be respected. It's tough here. She's old, probably has a subdural, but may not, probably isn't a good neurosurgical candidate, and has been sympomatic for an unknown period of time. Palliation is a likely pathway. However, it's not really appropriate to speculate on that until a physician has reviewed a CT. On one hand, the local ED with a CT can do this, ease some burden on the trauma center, and rule out some ddx. On the other, if she does have a significant subdural, we're just wasting time, waiting for secondary transfer. In an ideal world, I'd call a physican, respect that they have greater knowledge of this area, and ask their preference. This also avoids me having to take responsibility for a decision where there's good reasons to go both ways. Forced to make the decision myself, I would lean towards transporting to the trauma center.