I've fallen and I cannot get up!

[Just Plain Ruff]

It is 6:40pm and you are off work in 20 mins. Call comes in for a woman who needs help up off the floor. She’s not injured.

You think that this is going to be a simple pick up and leave call.

You arrive at the apartment after a 1 minute drive. It’s directly across from your hospital. You did not bring anything into the apartment with you. No med bag, no oxygen and no monitor. No cot either. Most of these pick up and leave calls at this apartment complex are just that. No care needed. Besides, this is the 4th time you can recall running this apartment number in the past year. Each time previously has been a pick up and put back in her chair. She just cannot get herself back up off the floor due to her weight and her arthritis.

You enter the apartment and are confronted with a disheveled apartment, cluttered with treasures (patients point of view), popcorn on the floor and a rather heavy elderly female lying buck naked on the floor.

Friends are covering her with a sheet to preserve her modesty

She adamantly says “I need help up and I’m NOT going to the hospital”

Once you have recovered from the flashing of a lifetime you get down to business.

You have every ALS gadget you can want.

You have a general acute care hospital 1 minute away by ground.

Your nearest specialty centers such as STEMI, Stroke and Trauma are 60 minutes by ground and 30 minutes by air.

Run with this one.

[Eydawn]

Mental status? Health history- long term and short term? How old is "elderly"?

Last oral intake? Last menstrual period?

BP, SaO2, pulse, respirations, skin color, condition and temperature?

Let's start with those...

Wendy

CO EMT-B

[Just Plain Ruff]

Mental status? Health history- long term and short term? How old is "elderly"?

Last oral intake? Last menstrual period?

BP, SaO2, pulse, respirations, skin color, condition and temperature?

Let's start with those...

Wendy

CO EMT-B

Ok, she's A&O X 3 She knows who the president is and she hates him. she also hates all "Them bastards in washington"

She is 79 years old

Type II Diabetes - diet controlled

Last oral intake - > 24 hours ago she fell at 6pm the night before

bp 210/104 Pulse = 84 RR = 16 skin color is pink cool and dry. Her oral temp - don't know

She continues to tell you, "Just pick me up and put me in the chair and you can leave. I don't need to go to the hospital" She's pretty adamant that she isn't going to go with you.

[Eydawn]

Nasty hypertension. What's her blood glucose?

Why did she fall? And how heavy is "rather heavy"? Are we lookin' at 200 pounds of grandma, or 400 pounds? If she's very obese, we could be looking at major tissue damage on the posterior side. Why was she butt naked? Incontinent at all?

Breath sounds? I know you initially said not injured, but what does my physical exam reveal?

Medications?

Wendy

CO EMT-B

[Just Plain Ruff]

Nasty hypertension. What's her blood glucose?

Why did she fall? And how heavy is "rather heavy"? Are we lookin' at 200 pounds of grandma, or 400 pounds? If she's very obese, we could be looking at major tissue damage on the posterior side. Why was she butt naked? Incontinent at all?

Breath sounds? I know you initially said not injured, but what does my physical exam reveal?

Medications?

Wendy

CO EMT-B

Ok, well your glucose monitor in the bag that you went out to get shows blank - the batteries are dead.

She said she stood up and slid down the chair.

she is pushing around 375+

yes she was totally naked

She had a large wet spot around her but she said that she just got done peeing for the 2nd time in the last hour.

the only injury you find is a abrasion to her wrist from the carpet with her trying to get to the door.

Lung sounds slightly congested but not a wheeze heard.

your partner is still trying to find batteries for the glucometer in the ambulance

She says she walks in her house naked all the time

You now have gotten her up off the floor. It was a real job but she was up. There is something very obvious that you see when you get her to the chair.

[Eydawn]

You want to clue me in as to what "obvious" thing I'm "seeing"?

--Wendy

[Just Plain Ruff]

You want to clue me in as to what "obvious" thing I'm "seeing"?

--Wendy

Now that would be too easy wouldn't it but I'll give it to you.

You look at her face and you see obvious left facial drooping and you notice her left arm is floppy. Theres more info but you have to ask for it.

You want to clue me in as to what "obvious" thing I'm "seeing"?

--Wendy

Now that would be too easy wouldn't it but I'll give it to you.

You look at her face and you see obvious left facial drooping and you notice her left arm is floppy. Theres more info but you have to ask for it.

[Chief1C]

Does she live alone? Is she able to ambulate, under other circumstances? Is there clear path of egress?

Does she have a telephone? > Call the ER, Medical Command, Ask him/her to talk to her about the dangers of dying, should she decide to stay home. > Call PD, they may be able to direct someone to address code violations, thus get her into a place where should could be better cared for.

[spenac]

Cincinnati stroke scale?

http://www.strokecenter.org/trials/scales/cincinnati.html

Does anyone else have power of attorney so they can override her no?

Is this droop something new or noted on your previous lift assists?

Request adult protective services to see if they can place her under their custody so she will have to be transported.

Any odor similar to alcohol on breath? Fruity breath?

[DwayneEMTP]

Age? Mental status? Any reason to believe that she is incompetent to refuse your care once you've thoroughly explained the threat to life that her symptoms present?

Dwayne