Trauma Case - "Slider"

[wrmedic82]

I wanted to break up the medical monotony with a simple trauma case.

You respond to a local softball field for the report of a traumatic injury. The scene is safe. As you approach the patient you notice a crowd of people around the patient waving you in. Upon arrival at patient you find a 30 y/o/m lying supine with a off-duty firefighter/paramedic holding a obviously injured left ankle. Bystanders report that the patient was attempting to slide into second base when a "pop" was heard from the dugout and the patient was screaming in pain.

Pertinent Info:

-No loss of feeling in extremity

-distal pulses are present

-Vitals: BP: 102/60, HR: 120, RR: 30, SpO2: 98% RA, ETCO2: 28

-Pain level 10/10

-Allergies: PCN

-Hx Hypothyroidism, OSA

-Weight: 96 kg

How would you care for this patient?

Edited September 14, 2012 by wrmedic82

[Just Plain Ruff]

Dilaupid Stat!!!!

[Happiness]

Do a complete set of vitals, and assesment. Ask the pt if he would like to have some entonox to help with the pain. Explain all side effects to the drug.. place in a pillow splint and use zap straps to secure to uninjured foot. Check pedals and apply ice for 10 min on 10 min off. Get onto stretcher and off we go monitoring the vitals and pain level.

[island emt]

Exactly what your picture shows.

Vacuum splint it. make sure pedal pulse is maintained.

IV, pain med of your choice titrated to maintain pt's comfort, & stability of his vitals.

Nice gentle ride to hospital with ortho capabilities.

Looks to be a combo dislocation with possible tri maleolar fx.

[ERDoc]

Pretty much what has been said. Splint however you want to minimize movement and go heavy on the narcs (or if Kiwi was here he'd say break out the Ketamine). This guy needs an xray and an orthopod.

[Eydawn]

How's this for ya? (Warning, NSFW! Graphic.) Went viral a few weeks back.

Wendy

CO EMT-B

RN-ADN Student

[wrmedic82]

Exactly what your picture shows.

Vacuum splint it. make sure pedal pulse is maintained.

IV, pain med of your choice titrated to maintain pt's comfort, & stability of his vitals.

Nice gentle ride to hospital with ortho capabilities.

Looks to be a combo dislocation with possible tri maleolar fx.

I will say this you were right on the money with tri maleolar Fx. There was also a midshaft fibula Fx that was found later on x-ray.

Do a complete set of vitals, and assesment. Ask the pt if he would like to have some entonox to help with the pain. Explain all side effects to the drug.. place in a pillow splint and use zap straps to secure to uninjured foot. Check pedals and apply ice for 10 min on 10 min off. Get onto stretcher and off we go monitoring the vitals and pain level.

I was intrigued by you adding entonox to your treatment plan and it makes sense after reading up on it. Of course I will admit I was the patient. But I want to use this experience to learn all that can be done when encountered with this to help me once I get back on the rig. I am a baby medic I will admit.

[island emt]

I will say this you were right on the money with tri maleolar Fx. There was also a midshaft fibula Fx that was found later on x-ray.

Recognized it right off the bat.

I wish i had a dollar for every one of these I've had to package over the past 4 decades. I'd be able to retire in style.

Had three just in the last two months, when tourists decide to climb down over the rocky shoreline to take photo's for the folks back home.

They are very ugly and extremely painful, with not much holding the foot onto the leg outside of tissue & shredded ligaments.

Takes a lot of fentanyl to make that pain go away.

edit to add: This is the kind of injury that needs to go to a hospital with a good ortho surgeon. This is not your everyday E R repair.

Edited September 18, 2012 by island emt