Lifting patient with possible dislocated shoulder

[QRScomplex]

This was a call I had at the BLS level and am curious how others would approach this.

We were toned out for a 65yo female who had fallen with a possible fractured hand. When we got there the patient was laying supine in the upstairs bedroom of a s 2 story home. She had apparently stumbled, hit the dresser on her way down with her left shoulder and was unable to get up on her own. Patient had been down for more than an hour as she wasn't able to reach the phone. No loss of consciousness or syncopy prior to fall. No other injures and c-spine cleared. CSM's present in all 4 extremities, patient alert x4, normal vitals. Not on any medication and only allergy was to oxy and could not take any narcotic pain killers. Due to the last we called of ALS for pain management.

The issue was getting the patient up off the floor and onto a stair chair to get her downstairs and onto the stretcher.

We ended up wrapping her in a sheet to keep the left arm as immobile as possible but any pressure to the shoulder or arm caused severe pain (7 out of 10 when not moving 10 out of 10 if pressure applied). Patient was approximate 190lbs. Attempts to manually lift her up failed due to he pain and the patient ended up maneuvering herself to her knees with some assistance to keep her from tipping back and the stair chair placed behind her. She was able to get into the chair with assistance.

My question is, are there other ways that services approach these types of lift situations either with lift assisting devices or other types of lifting aid's and if so what do you all do?

 

[TransportJockey]

I would use a scoop stretcher

 

[QRScomplex]

I would use a scoop stretcher

My initial thought was safety using a scoop stretcher going down stairs but I suppose with enough guys that would be a non-issue. Thanks for the feedback!


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[MonkeyArrow]

Honestly, I would just profusely apologize and attempt to move/lift the patient as quickly as possible. It's going to hurt for a few seconds but it's the most efficient way.

 

[SpecialK]

Combi-carrier would be best because she doesn't have to move much, and can put the entonox cylinder between her legs.

 

[NomadicMedic]

Scoop stretcher and a paramedic with fentanyl.

 

[QRScomplex]

Scoop stretcher and a paramedic with fentanyl.

Do paramedics carry pain meds that are not opiate-based? She refused any narcotics which is why we called off ALS.


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[NomadicMedic]

Do paramedics carry pain meds that are not opiate-based? She refused any narcotics which is why we called off ALS.


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Not anything I'd give to her. However, people who don't want to take opiates seem to change their tune when they're being man handled down a flight of stairs. And she's "allergic" to oxy? I hear that a lot. When I ask what happens invariably I'm told, "well, I get a little sick to my stomach, get dizzy and kind of loopy". I'm always like, that's the expected action not a side effect. Do doctors ever explain what patients can expect when they take opiate based medication? It's not like taking an APAP.

 

[TransportJockey]

Do paramedics carry pain meds that are not opiate-based? She refused any narcotics which is why we called off ALS.


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Some. I used to carry toradol and some places carry ketamine too

 

[QRScomplex]

I'll have to think twice about ALS then in future situations. Thanks guys for the feedback!


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[WolfmanHarris]

We carry keterolac as well. I'd consider 30mg IV for pain. If the injury is isolated I'm inclined to assist them to standing and help them walk down the stairs. Stair chair or scoop are both going to place pressure on the shoulder. Pop in a lock, push keterolac, maybe combo with Morphine or fentanyl as carried, then splint/sling and walk out of the house to the stretcher.

 

[DesertMedic66]

We carry keterolac as well. I'd consider 30mg IV for pain. If the injury is isolated I'm inclined to assist them to standing and help them walk down the stairs. Stair chair or scoop are both going to place pressure on the shoulder. Pop in a lock, push keterolac, maybe combo with Morphine or fentanyl as carried, then splint/sling and walk out of the house to the stretcher.

This. Walking may be the most painless option for this patient. Pain meds, splint the area, walk the patient if stable on her feet

 

[NomadicMedic]

I guess I missed that part that said she was able to walk. In that case, ABC. (Ambulate before carrying).

 

[akflightmedic]

Do paramedics carry pain meds that are not opiate-based? She refused any narcotics which is why we called off ALS.

You are asking about a better way to lift/carry/position a patient who is heavy (190 pounds), has a flight of stairs involved, already injured and elderly....and part of the plan was to wave off ALS due to patient denying any pain control (at that time)? Was any consideration given that more manpower or a different perspective would be a benefit? Just sayin...you had tools at your disposal and decided to not use them.

 

[Tigger]

Some places (like here) allow for field shoulder reductions. While I am not going to use a recently reduced shoulder as a lifting point, it would likely help with the pain and extrication process.

 

[StCEMT]

Her legs work, so I am not gonna carry her downstairs. I will apologize for the discomfort and stand her up. Depending on available meds, maybe some before moving her. Immobilize it once she is off the floor.

 

[DrParasite]

We carry keterolac as well. I'd consider 30mg IV for pain. If the injury is isolated I'm inclined to assist them to standing and help them walk down the stairs. Stair chair or scoop are both going to place pressure on the shoulder. Pop in a lock, push keterolac, maybe combo with Morphine or fentanyl as carried, then splint/sling and walk out of the house to the stretcher.

it's an isolated upper extremity injury.

I'm glad someone else thinks that having her walking down using her uninjured lower extremities is better than carrying her down the stairs.

 

[akflightmedic]

I have no problem walking a patient. However, we have an elderly patient who fell, lives alone and states she stumbled upon which she was not able to get up for well over an hour. While her stumble may have been just that...a stumble, we do have to wonder if there were any underlying new conditions at work here. Am I reaching? Absolutely, however which is the more sound practice? Put an already injured, elderly patient at further risk for another stumble walking her down the stairs or simply securing her arm and then put her in a stair chair which should be managed by trained technicians on proper lift techniques and securing adequate crew resources?

If you want to go all American on this one, you could also ask which one puts the service at more liability risk as well...but for now, the patient is being discussed and what would be best. We do not know the layout of the house and whether or not it was cluttered with stuff or cats. Could be spotless for all we know. My point is, in this case there are plenty of reasons to carry in a chair rather than make her walk. It simply is not that cut and dry.

 

[TransportJockey]

I spaced that he said the pt is ambulatory

 

[SpecialK]

We have the following non-opiate pain relief:
Paracetamol
Ibuprofen
Entonox
Methoxyflurane
Ketamine

Opiate or opioid medicines:
Tramadol
Fentanyl
Morphine

Most patients who reckon they are "allergic" to morphine have just had a bad experience on it, and it is not true allergy.