# 70 y/o aphasia s/p fall



## Tony Ippolito (Apr 1, 2016)

Hey guys, new to this site and it seems awesome! I have been an EMT for awhile now and run into calls that stump me and would love feedback on this one. 

70 year old female who rolled out of bed. Upon arrival she has snoring respirations, and was mumbling incoherently. I quickly performed a jaw thrust maneuver which was ineffective. I log rolled her, palpated her spine, and at his time she was fighting me to sit up, so I helped her. (Might been a bad move but with so much new study showing less backboarding I took the risk.) 

She started breathing better, but was totally aphasic! She was ax0-0, and normally is ax0-3. Her blood glucose was normal, and Bp was high as well as HR. Als arrived and she showed a-fib on monitor. 

Basically, my question is; what are some ways you guys further assess with someone who is aphasic? 
I attempted to have her squeeze my arm when she felt pain on my assessment and that worked slightly. 


(She ended up having her 4th stroke with a run of uncontrolled a-fib.)


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## ERDoc (Apr 1, 2016)

I'm not sure what you mean by ways to further assess someone with aphasia.  Do you mean ways to communicate with them?  Having them squeeze is a great way.  You can also have them answer yes/no questions (limits the history a bit), write things down or type on a computer/smartphone.  If you mean tests to better assess the cause of the aphasia then perform a good cranial nerve exam and NIH stroke scale.


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## Tony Ippolito (Apr 1, 2016)

ERDoc said:


> I'm not sure what you mean by ways to further assess someone with aphasia.  Do you mean ways to communicate with them?  Having them squeeze is a great way.  You can also have them answer yes/no questions (limits the history a bit), write things down or type on a computer/smartphone.  If you mean tests to better assess the cause of the aphasia then perform a good cranial nerve exam and NIH stroke scale.


Yes, that's mostly what I mean. I guess I'm so use to assessments where the patient is either talking coherently or unresponsive, and not in between that I got stuck when I couldn't gather information.


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## Tony Ippolito (Apr 1, 2016)

Bu


ERDoc said:


> I'm not sure what you mean by ways to further assess someone with aphasia.  Do you mean ways to communicate with them?  Having them squeeze is a great way.  You can also have them answer yes/no questions (limits the history a bit), write things down or type on a computer/smartphone.  If you mean tests to better assess the cause of the aphasia then perform a good cranial nerve exam and NIH stroke scale.


but thank you for that advice! Makes sense and I will implement that. We need some of those face pain sheets as well.


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## ERDoc (Apr 1, 2016)

Welcome to the real world of medicine, where nothing ever follows the textbook.  I suck at lip reading so when someone is trached it is a long, difficult conversation.


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