Weird Call Need Some Opinions

[rat115]

I live in an area with a large elderly population per capita. I've seen similar a couple of times because of this. We are instructed to lean to a worse case scenario if there's doubt.

The pt hx of having been into the doctor for x-rays late the previous week would have me thinking as you did on scene. (Any known hx of osteopnea or osteoporosis? Pt on Ca+?) I would be worried about a non-displaced fx. While I may not have used a reversed KED, I would have prevented the number of moves you had. Here, our normal practice is to use a scoop (if possible and no chance of other injuries like in this situation). This would have prevented movement of the pt's hips after initial placement on the scoop and allowed movement to the cot and ER bed without extra movement of the body.

On scene, did anyone attempt slight manual traction of the pt leg? I've done this in the past and was able to relieve the pain and was later confirmed that it was a femur fx. I've also had a pt with a hip and lateral pelvic fx who's pain was relieved by a traction splint, the ER here told me to leave it off the pt on ground transfer to higher level of care due to the pelvic fx, and I had an ortho PA tell me there that I should have followed my gut and put it back on her because it lowered the pt pain level even though the ER here told me not to.

Moral, don't take for granted with elderly pts that pain without visible injury means that nothing's broken. Finding a way to make the pt comfortable and not have to repeatedly move them is the best thing you can do to prevent displacement if there's a chance of fx.

[46Young]

Well what are you suggesting you should have done differently? Sometimes fractures are not obvious in the field, and clinical presentation can change with time and position. Your case wasn't the first that seemed to present differently in the ED. Don't forget that a "hip" fracture is usually a proximal femur fracture anyways, so the end result wasn't really all that different from what you had originally suspected.

I haven't found that the "reverse KED trick" does all that great of a job for hip fractures. If I suspect a hip fracture I usually stabilize with pillows, use pain control, and get some extra help to move the patient gently. It sounds like you guys did pretty much the same thing.

Pillow splint and pain management sounds good to me. I use either a SAM sling or the KED for pelvic fractures. not hip fractures. Like you said, a suspected hip fx may really be a proximal femur fx. You're not going to pull traction for anything other than an obvious midshaft femur fx, so you wouldn't have done anything wrong on that account.

Edited February 17, 2011 by 46Young

[Happiness]

I to have had this call....but I was fortunantly the higher level medic so I didn't have to concure with anyone. 70 yr old female just sort of stumbled hung onto a TV and placed herself to the floor, vitals great, no pain, no bruising, no rotation, no shortness in the leg. This female is very healthy and was on no meds for anything. My partner and I decided that hope for the best and prepare for the worst.

We thought it would be best to treat as a fracture, zap strapped the hips, knee area and the ankles, with a blanket between the legs. We then scooped her onto the cot, luv the scoop as it make transfering to the ED bed so much easier and smoother. When the exray's were done walaaaa a femur fracture.

If you did a blanket transfer from your cot to the ED bed, that is probably where the fracture actually broke.

I was wondering do you guys have what is called a golden slipper on car. It is basically a half slidder that fits under the mattress of your cot. If used properly it would have saved one transfer.

Sometimes we just dont know and Ugly you didnt fail you just learned something........

[tniuqs]

A set or 4 of those BCAS type zap straps fell (I like em )into my own kit one day ... funny how that happens eh ?

And correct me if I read something wrong because when doing medivacs into and out of BC the "clam shell" term was used I was like wtf ? .. the scoop was a term only used east of the rocky mountains well so I though ?

cheers

[PCP]

Hapiness I agree with you 100% I love the Golden slipper for transfering patients from our cot to the hospital bed or from a chair to our cot. As well as the clam shell (scoop to some people) is by far one of the best pieces of equipment we use on car. I find that many paramedics I work with forget about the Golden slipper and just use the blankets when moving the patient. Golden slipper is sooo much easier on your back

[Happiness]

A set or 4 of those BCAS type zap straps fell (I like em )into my own kit one day ... funny how that happens eh ?

And correct me if I read something wrong because when doing medivacs into and out of BC the "clam shell" term was used I was like wtf ? .. the scoop was a term only used east of the rocky mountains well so I though ?

cheers

squint I used the scoop term for you...... and I want my zap straps back Im going to tattle to the Unit chief in Prince George on you And the clam shell very rarely goes on medivacs (only if your a spinal pt) you must be refering to the #9.

[uglyEMT]

All great posts. Now that you mentioned it (hindsight is 20/20) she did mention when I tried to move the leg a little it "felt better". Granted I don't actually remember how I moved the leg at this point but I did move it slightly. I think I moved it towards me, ala traction, to get closer to the patient.

As for the number of transfers, unfortunately it couldn't be helped. Very small room she was in, 20 steep steps with ice on them, narrow alleyway. That's the option for the stair chair (not my call I felt a backboard with the patient spidered for the move would be perfect).

I do know about the transfer board, my Mom uses it for my Dad (he is a quad) but alas we do not have it on the rigs, guess I could use a short board or a pedi board in the same way. We do have a scoop but what's funny is I am about the only one who knows how to "properly" use it. I know this because I work in an industry (my day job) where we use it a lot and way before medical teams arrive. Yes squints even in the States some folks call it the clam shell because it opens like a clam. In my industry it goes by Jacobs Box (from the term Jacobs Ladder) also have heard it called clam box, scoop box, scoop stretcher, grabber, and even dead lift cot.

So from what I am gathering from the posts. I did a great assessment, the fracture wasn't enough to diagnosiin the field, the extended movements caused it to complete, should have tried some sort of stabilization, kick my team in the head for not listening to me, did not fail but learned a valuable lesson for the future.

Can't wait to hear what Dwayne has to say on the subject

[tniuqs]

squint I used the scoop term for you...... and I want my zap straps back Im going to tattle to the Unit chief in Prince George on you And the clam shell very rarely goes on medivacs (only if your a spinal pt) you must be refering to the #9.

Shucks thanks for interpreting for me, Zap straps ... what Zap straps ?

Yeah still laughing about BCAS flight program the # 9 for the standard medivac cot, that system is so frigen old to be embarrassing ever hear of lifeport ... way easier on the pilots backs

Not following on your medivac comment but when there is a spinal its a sandwich of: patient, cotton sheets padding, scoop, onto LSB, all one piece speed clip and or spider when the possibility of tubulance exists .. that pretty much every day.

And now back to the golden shower ... oops slipper ... speaking of weird .

Yes squints even in the States some folks call it the clam shell because it opens like a clam. In my industry it goes by Jacobs Box (from the term Jacobs Ladder) also have heard it called clam box, scoop box, scoop stretcher, grabber, and even dead lift cot.

So from what I am gathering from the posts. I did a great assessment, the fracture wasn't enough to diagnosiin the field,

Can't wait to hear what Dwayne has to say on the subject

[crotchitymedic1986]

Your mistake was in not reassessing the patient during transport. Luckily, didn't cost your patient their life, so its a good learning experience. Sometimes with hip dislocations, it is possible for the patient to pop the hip back in place by trying to get off the floor (or when you move the patient). The femur probably became displaced when you put her on the stretcher and straighten out her legs.

[tcripp]

I suggest a reverse KED due to a high index of suspition (treat for the worst thinking here).

Okay, I give. What is this?