# Question from a quiz in my class



## emergancyjunkie (Sep 13, 2011)

Got this from a quiz from my class
A patient with with a history of diabetes and multiple heart attacks falls down three stairs. His right wrist is deformed on the radial side. Would you consider this as a medical and trauma call or just a trauma call.

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## Shishkabob (Sep 13, 2011)

Who's to say the fall wasn't caused by a medical condition, or the patient just tripped.  Or gremlins.  When in doubt, gremlins are the cause.


Nothing is absolute, everything is interconnected.


I don't really like answering a quiz question, especially since you're on your phone and as such, could still be taking the test.


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## abckidsmom (Sep 13, 2011)

I would consider it to be a stupid question.  What's the point of drawing a box around "medical" or "trauma?"

If a person with a complicated medical history is under extreme stress (like having a broken wrist) a competent health care practitioner will be aware that there's a possibility that the patient will have complications unrelated to the trauma from his medical problems.


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## Katy (Sep 13, 2011)

abckidsmom said:


> I would consider it to be a stupid question.  What's the point of drawing a box around "medical" or "trauma?"
> 
> If a person with a complicated medical history is under extreme stress (like having a broken wrist) a competent health care practitioner will be aware that there's a possibility that the patient will have complications unrelated to the trauma from his medical problems.


This.


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## emergancyjunkie (Sep 13, 2011)

Linuss said:


> Who's to say the fall wasn't caused by a medical condition, or the patient just tripped.  Or gremlins.  When in doubt, gremlins are the cause.
> 
> 
> Nothing is absolute, everything is interconnected.
> ...



Took the quiz last night. I never have my phone turned on in class unless I have pa bls protocal up. I really didn't not understand why that would be considered a trauma call and not a trauma medical call considering the fact that the patient has a history of diabetes. 

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## Shishkabob (Sep 13, 2011)

emergancyjunkie said:


> Took the quiz last night. I never have my phone turned on in class unless I have pa bls protocal up. I really didn't not understand why that would be considered a trauma call and not a trauma medical call considering the fact that the patient has a history of diabetes.
> 
> Sent from my Desire HD



Let's look at differentials,


Possible hypoglycemic event causing the fall.
Possible syncopal episode causing the fall.
Possible AMI causing a syncopal episode causing the fall.
Possible stroke due to a history of coronary diseases, causing the fall.
Or the patient just tripped and fell.


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## JPINFV (Sep 13, 2011)

Why does it matter if it's a trauma call or a medical call?


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## emergancyjunkie (Sep 13, 2011)

So if you ran into this in the field what would most of you consider this. If I ran into this even though I'm still a student I would still consider a medical reason for the fall and treat as medical/trauma

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## Shishkabob (Sep 13, 2011)

I'd poke and prod the medical aspect as a cause for the fall, but honestly more often than not the patient denies any feelings before the fall, even if they did have them.  They just want to play it off as being clumsy, hoping it wasn't something more.


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## emergancyjunkie (Sep 13, 2011)

JPINFV said:


> Why does it matter if it's a trauma call or a medical call?



It really doesn't matter in the long run as long as the patient gets the right treatment for his/her deformity in the wrist. 

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## JPINFV (Sep 13, 2011)

emergancyjunkie said:


> It really doesn't matter in the long run as long as the patient gets the right treatment for his/her deformity in the wrist.
> 
> Sent from my Desire HD


What about the right treatment for what ever caused the fall (besides gravity).


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## emergancyjunkie (Sep 13, 2011)

JPINFV said:


> What about the right treatment for what ever caused the fall (besides gravity).



Well for that I would have to do a medical assessment. So if the patient has a history of diabetes and my protocal states that I could do it I would get a bgl and if the bgl calls for it i also treat it as well with oral glucose. If that was normal I would consider an als assist for a 12 lead to see if it was heart related. I would have to agree with linuss on what he would do. I would sleep better at night if I knew that the patient was just being clumsy then have a real medical problem that caused it. But in pa bls units can't get a bgl according to protocal.

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## fast65 (Sep 13, 2011)

emergancyjunkie said:


> It really doesn't matter in the long run as long as the patient gets the right treatment for his/her deformity in the wrist.
> 
> Sent from my Desire HD



False, treat the cause first. Think of the deformed wrist as distracting injury, if you treat it, but not the hypoglycemia that caused the fall that caused the deformity, then are you really providing the best care possible?


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## emergancyjunkie (Sep 13, 2011)

fast65 said:


> False, treat the cause first. Think of the deformed wrist as distracting injury, if you treat it, but not the hypoglycemia that caused the fall that caused the deformity, then are you really providing the best care possible?



That is if there is a cause for the fall. But I see what you are getting at. Before I treat the deformity I should try to find a cause and treat that first.... Dang that's I love this forum everyone makes me think about how things should be done

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## fast65 (Sep 13, 2011)

emergancyjunkie said:


> That is if there is a cause for the fall. But I see what you are getting at. *Before I treat the deformity I should try to find a cause and treat that first*.... Dang that's I love this forum everyone makes me think about how things should be done
> 
> Sent from my Desire HD



Exactly. Not every fall has some sort of hidden medical cause, but it's something you need to rule out.


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## JPINFV (Sep 13, 2011)

1. As with some other things, I hate the delineation between "trauma" and "medical." How about we just do an assessment?

2. Is there no reason why you can't be multitasking and, say, taking a medical history while splinting the wrist?


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## bigdogems (Sep 13, 2011)

Was this a multiple choice question or open ended? Keep in mind this is a question he had in class. So while we can debate it on here wiyh all the "what ifs" That isnt an option in school

From a class view. I would say as long as the pt is alert and denies loc I would go with a focused trauma assessment

Now real world your going to check a sugar, get a 12 lead, ect to make sure there wasnt a cause for the fall except gravity


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## Handsome Robb (Sep 13, 2011)

"So what happened before you fell, sir?"


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## NomadicMedic (Sep 13, 2011)

Yeah. I'd treat the trauma, then as I was getting the hx, I'd make sure I got a sugar, did a 12 lead and ruled out any medical aspects. 

But, as a basic, treat the trauma. 


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## emergancyjunkie (Sep 13, 2011)

bigdogems said:


> Was this a multiple choice question or open ended? Keep in mind this is a question he had in class. So while we can debate it on here wiyh all the "what ifs" That isnt an option in school
> 
> From a class view. I would say as long as the pt is alert and denies loc I would go with a focused trauma assessment
> 
> Now real world your going to check a sugar, get a 12 lead, ect to make sure there wasnt a cause for the fall except gravity



It was a multiple choice when I took the test I put medical trauma. But the correct answer was trauma when I asked why it wasn't both my teacher told me there wasn't anything saying that the cause was diabetes or heart. But by posting this thread I know know that if I actually had this as a call that my answer on the test would have been correct if I did treat as a medical/trauma
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## Katy (Sep 13, 2011)

emergancyjunkie said:


> my teacher told me there wasn't anything saying that the cause was diabetes or heart.
> Sent from my Desire HD


You can't know that until you successfully evaluate the patient for those causes, you can't automatically rule them out because you weren't handed the info on a silver platter. But, I'm glad you learned something.


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## Handsome Robb (Sep 13, 2011)

emergancyjunkie said:


> It was a multiple choice when I took the test I put medical trauma. But the correct answer was trauma when I asked why it wasn't both my teacher told me there wasn't anything saying that the cause was diabetes or heart.



Yay for NREMT prep and not actual teaching. No offense.


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## Scott33 (Sep 13, 2011)

emergancyjunkie said:


> It was a multiple choice when I took the test I put medical trauma. But the correct answer was trauma when I asked why it wasn't both my teacher told me there wasn't anything saying that the cause was diabetes or heart. But by posting this thread I know know that if I actually had this as a call that my answer on the test would have been correct if I did treat as a medical/trauma
> Sent from my Desire HD



What do you mean when you say "treat as a trauma"?


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## SHESCOOL (Sep 13, 2011)

I agree. You don't know if the fall was caused by the medical condition. You would have to further assess the patient


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## rmabrey (Sep 13, 2011)

NVRob said:


> Yay for NREMT prep and not actual teaching. No offense.



^^^^^ this. There is the NREMT then there is the right way. You have to differentiate the two, especially if you do a lot of ride time (more than the ridiculous requirement)


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## emergancyjunkie (Sep 13, 2011)

Scott33 said:


> What do you mean when you say "treat as a trauma"?



The question stated that the patient had a deformity on the radial side of his right wrist. So the NREMT says that is a trauma call. But the patient also had a history of diabetes and multiple heart attacks. So when I answered the question i said it was both medical and trauma because of all the info I got from the question.

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## bigdogems (Sep 13, 2011)

NVRob said:


> Yay for NREMT prep and not actual teaching. No offense.



I think the instructor should have done more teaching to real world. But the tests do need to be geared towards how registry will be written. It really doesn't matter if you learn a ton of stuff in class but can never pass registry to get your state cert. Im not saying this is right but its how it is. Personally I thing National Registry needs a complete overhaul of their testing process. Their written doesn't measure knowledge. It measures test taking skills


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## emergancyjunkie (Sep 13, 2011)

bigdogems said:


> I think the instructor should have done more teaching to real world. But the tests do need to be geared towards how registry will be written. It really doesn't matter if you learn a ton of stuff in class but can never pass registry to get your state cert. Im not saying this is right but its how it is. Personally I thing National Registry needs a complete overhaul of their testing process. Their written doesn't measure knowledge. It measures test taking skills



I haven't taken it yet but from what I hear about it I agree 

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## DesertMedic66 (Sep 13, 2011)

My call in to the hospital would more then likely say trauma. Just because the patient has a medical history doesn't mean that was the cause of the fall, BUT it also could be the cause. I'm going to treat the trauma first and as I'm doing that I'm going to be assessing to see if there may be a medical reason to the fall. 

Based off the limited info in the test question I would have said just trauma.


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## d0nk3yk0n9 (Sep 14, 2011)

I'd say that in a testing scenario, especially a multiple choice question, the best way to decide whether they want you to think of it as trauma or medical is to say to yourself, "What's the chief complaint likely to be?" In this case, the chief complaint is probably that the patient hurt his wrist when he fell, so it's a trauma. 

In the real world, obviously, this distinction is useless and contrived, as many people have already said.


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## Wes (Sep 14, 2011)

And this is but another outstanding example of what's wrong with EMS education and BLS "training" in particular.


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