Weird Call Need Some Opinions

[BrianH24]

I don’t have any advice or suggestions as im still in school. And giving advice on this seems inappropriate to me. Your all allot more experienced then I. I just wanted to say thanks for sharing though because I enjoy reading these things and I feel like I always walk away from them learning some things. I’m sorry that happened Ugly. I guess some times like they say “sh*t happens”… But I know what you mean, The old “s happens” isn’t really a satisfying answer. I hate settling for an unclear answer. Its so frustrating. Im always trying to figure out “why?“ I wish I had more to offer.

-Brian

[uglyEMT]

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.

Umm reread the first post we reassesed multiple times. It wasnt until the ED that the fracture became evident.

Okay, I give. What is this?

Take the KED turn it upside down, wrap the hip with the lower (now upper) flaps, wrap the limb (in this case left leg) with the top half (now lower) of the KED and secure the straps in the same order as usual. Basically a real nice splint for hip and upper femur fractures.

[tcripp]

Take the KED turn it upside down, wrap the hip with the lower (now upper) flaps, wrap the limb (in this case left leg) with the top half (now lower) of the KED and secure the straps in the same order as usual. Basically a real nice splint for hip and upper femur fractures.

Hmmmm. Not sure if we ever covered that in school...or not.

Thanks. I will definitely keep that in mind for the future.

[crotchitymedic1986]

If reassesed "several times" the amazing bruise would have been noted prior to arrival at the ER. Using a KED upside down is for a hip fracture, not a femur fracture.

[NYCEMS9115]

Well, if you don't suspect something; you won't find it. Obviously, she was in pain and BLS treatment for pain; is immobilization. I don't know how the patient was really moved but your experienced EMTs aggrevated an incomplete fracture. Its very common among Geriatrics to have incomplete fractures and fractures from simple slips and falls. It is what it is. You have suspect it; in order to treat for it. All the best...

[DwayneEMTP]

Did you fail? Of course. Your patient arrived at the ER in a condition worse that when you took over pt care, right? And it's your job to make them better, not allow them to get worse, right? So isn't the fail obvious?

The questions really is, in my mind, did you do the best you could? Were you lazy, complacent, fail to reassess thoroughly enroute, yadda, yadda, yadda. No? Good on you, then you did your best today, and tomorrow I am more than willing to bet that your best will be better. And you know what? Without a fail today, tomorrow your best would be the same as it was yesterday, right?

I'm confident that I've failed on every call that I've ever run, and certainly on every significant tall that I've ever run. The proof? That at the end of each of those calls I've looked back, either alone or with the help of my partner, and thought, "Dang it, I wish I would have done X instead of Y." "I wish I would have hit my first IV,..." I wish, I wish, I wish....

What is the epic fail? To run your calls and not learn from them. It sounds like your logic was good, your assessment sounds good, but I don't believe that this pt was sound until the moment the ER cut her pants off and then spontaneously developed a bruise and a fracture. Unless there is 'Flash Hematoma" that I'm not aware of? (I know it can sometimes happen pretty quick, but you know what I'm saying.)

So yeah, you likely failed, and that should make you want to be better. When you don't fail...when you finally do every single thing right on one of these hinky calls? You will then have entered the club of those folks we all know that bullshit themselves about how good they are and have excuses for everything.

My ultimate goal is to someday consider myself a peer of those hardcore medics that we also all know, the ones that make way fewer mistakes than I do.

Good post man. What should you, could you have done differently? No friggin' clue.

Dwayne

Edited to fix typo.

Edited February 19, 2011 by DwayneEMTP

[uglyEMT]

Thanks guys. Thanks for the input Dwayne I appreciate it. I like that saying that without the fail I will never learn.

Thanks for the heads up on geriatric patients. I knd of thought along that route but as stated I can only treat what I find. Without the break being evident intially I think the crew was complacent on not immobilizing. I will fight harder next time!

[tniuqs]

Fail on this call ... extremely harsh and judgemental, did the woman suffer, did your care negatively change the outcome or cause more damage ... no that would be stretching it I think.

Do you Fail when a patient dies while in your care, when you did everything in the book and then some.

You stated that there was no clear indication of fracture upon PE, the patient was in your care for only 10 mins ?

The only fail was you listened to partners that did not actually do an examination (if I read this OP correctly) those partners failed, you were influenced because they "supposedly" had more experience, follow your gut instinct its seldom wrong.

cheers

[uglyEMT]

Yea squint on initial PE no outward indication of a fracture, had strong distal PMS, no rotation, no bruising, no shortening of the leg. Just pain. Yes they just watched while I did the PE, taking history from the husband, getting the meds down but didnt actually PE. I wanted the KED but was talked out of it. I took their "experience" above my own (hell I still feel wet behind the ears sometimes).

It was a FAIL, I get it. Nothing harsh about saying it, I need to own it to move on and be a better provider.

Thanks guys and gals.

[mobey]

Using a KED upside down is for a hip fracture, not a femur fracture.

Just want to point out, that this is playing semantics.

Depending on the Medic/Nurse/Doc/Orthopedic surgeon... or anyone else you are talking too, the general consensus is, a "hip" fracture is anything from the upper neck of the femur, into the pelvic socket, and may include the iliac crest.

Since... as you know... there is no bone called a "Hip"