# Called for a Fall



## 94H (Dec 20, 2010)

Had a call a few days ago, kinda one of those calls where I didnt know what to do so reverted to the basics.

Called to pt's house after a fall unknown down time, last time pt was seen ambulating was night before, brother called EMS while checking in. Brother found pt lying on floor at around 1100 called EMS at 1500. Pt found curled in ball on floor, AMS as per brother, Responsive to Verbal Stimuli, Combative, Not Oriented. 

Pulse 98
BP 220/PAL
Resp: 16
Cap Refill >2 seconds
Lungs Clear

Pt fully immobilized since he was a Trauma ED at local hospital and protocols state we immobilize if falls are found still on the ground.

Once in the Ambulance

BP 190/110
P: 136
RR: 18
SpO2: 93

Put him on 10 LPM via NRB, Trauma Assessment, Requested ALS and Transport

Anything else I could have done? 

This was a BLS Basic-Basic truck


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## TransportJockey (Dec 20, 2010)

Out here a BLS truck would have gotten a CBG. Why the 10LPM? A N/C at 4 probably would have worked just fine.


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## 94H (Dec 20, 2010)

CBG? 

In retrospect I should have had him on a NC, but I guess I just reverted back to my EMT class training. I was kinda like "oh :censored::censored::censored::censored:", I guess working on an ALS truck has dulled my basic skills


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## TransportJockey (Dec 20, 2010)

Capillary Blood Glucose. Also known as BGL


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## 94H (Dec 20, 2010)

Blood Glucose Checks are not in my scope of Practice in PA, its a very archaic basic system


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## foxfire (Dec 20, 2010)

Seriously! ?you are not allowed to check blood sugar level. Wow.


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## JJR512 (Dec 20, 2010)

foxfire said:


> Seriously! ?you are not allowed to check blood sugar level. Wow.



Many EMT-Bs are not able to check blood glucose levels. Maryland is the same way. It's an optional local protocol, but is not part of the state-wide protocols. My county (Howard) is going to roll it out next year, from what I've heard.


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## Aidey (Dec 20, 2010)

Why was a basic truck transporting this patient?


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## 94H (Dec 20, 2010)

Aidey said:


> Why was a basic truck transporting this patient?



Dispatched as a Bravo (Non-Life Threatening) Fall. Basic Trucks can get Alpha and Bravo (lowest priority) calls in my area.


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## vquintessence (Dec 20, 2010)

What did your head-to-toe trauma assessment yield?  Any particular findings?

PMHx or a medication list?

Baseline mental status per the brother?


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## firemedic07 (Dec 21, 2010)

in NC we are pretty agressive, we get to do CBG's and alot of things. and here we run only paramedic level trucks. so im always paired with a paragod. so we dont have to call for als.


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## Melclin (Dec 21, 2010)

How old is this guy? Does the scene suggest anything in particular? I don't know whether to ask about drug paraphernalia or an NFR order. 

Pupils?

Neuro deficits?

Speech?

Skin colour/temp?

I wouldn't have collared/boarded him from what you've said, but I understand that you sometimes don't get a lot of choice about these things in your part of the world.


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## Simusid (Dec 21, 2010)

Melclin said:


> How old is this guy? Does the scene suggest anything in particular? I don't know whether to ask about drug paraphernalia or an NFR order.
> 
> Pupils?
> 
> ...



I guess I'm too conservative.   I would have boarded and collared him with an unwitnessed fall and AMS.  Do we know more about the fall?  was this down stairs or off a bed?  Was he fetal because he was guarding his abdomen?


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## 94H (Dec 21, 2010)

PMH: Chromes, Prosthetic R shoulder, and a previous CVA

Pt was on Cumadin and some other ones I cant remember (Just things for pain), had a fall about 2 weeks prior. Is usually ambulating and lives independently.

Pt in his late 60s, all he would say was "no" when we would try to move him, and he had "pain shakes" according to his brother. 



Assessment revealed soft, non-tender and otherwise unremarkable abdomen. No Bleeding, deformities, crepitus, bruising or anything else out of  the ordinary. Pt had PMS x4, skin a bit cool to the touch and dry

Our thinking was he got out of bed and fell sometime during the night from a standing height. He might have hit his head on a dresser, no other objects around


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## MrBrown (Dec 21, 2010)

Aidey said:


> Why was a basic truck transporting this patient?



Why does this guy need ALS, Brown wouldn't ring up Intensive Care for him


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## Aidey (Dec 21, 2010)

ALS for:

Hopefully a thorough assessment (pupils anyone?)
Blood sugar check, and treatment if needed
EKG & IV. Patient is a candidate for rhabdo.


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## 94H (Dec 21, 2010)

Aidey said:


> ALS for:
> 
> Hopefully a thorough assessment (pupils anyone?)
> 
> ...



I was looking for sugar check and EKG, plus pt was ALS per protocols (AMS, tach)


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## uhbt420 (Dec 22, 2010)

i would have called ALS because of that BP.


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## Anjel (Feb 3, 2011)

Why was the pt on the floor 4 hours from the time the brother found him and when he called EMS? And still on the floor when you got there? That doesn't seem right to me. Unless I missunderstood. 

Pt found at 1100 EMS called at 1500?

What in the world?


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## cruiseforever (Feb 8, 2011)

Pt. has altered LOC.  I would think of a head bleed.  He is on Coumadin.


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## phideux (Feb 9, 2011)

cruiseforever said:


> Pt. has altered LOC.  I would think of a head bleed.  He is on Coumadin.




Yeah, BP up, Pulse up, How is his breathing at 16-18bpm? Normal, labored, erratic?
Got up out of bed, FDGB, hit head.


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## MrBrown (Feb 9, 2011)

uhbt420 said:


> i would have called ALS because of that BP.



And what is a[n Intensive Care] Paramedic going to do for that BP? Jack is what.

Sounds to Brown like he has a head bleed.

Put patient on stretcher, take to hospital.


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## Rubles (Mar 22, 2011)

*How to check breathing rate?*

For a person lying in a curled-up position on the floor, how would you check breathing rate if you didnt have a stethoscope? (since we wudnt be able to see the rise and fall of the chest and might not easily hear him breath). 

Checking breathing rate might not be important in certain cases if support is on the way, but what if we're performing a triage; we wud have to check breathing rate (among other things), assign a tag and then move on to the next casualty.


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## Rubles (Mar 22, 2011)

^^^

Im guessing the only solution would be to move the patient into a supine position


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## usalsfyre (Mar 22, 2011)

Rubles said:


> For a person lying in a curled-up position on the floor, how would you check breathing rate if you didnt have a stethoscope? (since we wudnt be able to see the rise and fall of the chest and might not easily hear him breath).
> 
> Checking breathing rate might not be important in certain cases if support is on the way, but what if we're performing a triage; we wud have to check breathing rate (among other things), assign a tag and then move on to the next casualty.



An actual number is really pretty useless, look for adequacy and labor of respiratory effort.


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## Rubles (Mar 22, 2011)

so even for that, we wud have to move the patient into supine position, wouldnt we?


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## Anjel (Mar 22, 2011)

Rubles said:


> so even for that, we wud have to move the patient into supine position, wouldnt we?



well ur not gonna leave him curled up in a ball. 

so yes


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## NomadicMedic (Mar 22, 2011)

Too many unknowns to even hazard a guess.

BGL? Temp? Skin? Pupils? Posturing?


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## firetender (Mar 22, 2011)

Rubles said:


> For a person lying in a curled-up position on the floor, how would you check breathing rate if you didnt have a stethoscope? (since we wudnt be able to see the rise and fall of the chest and might not easily hear him breath).
> 
> Checking breathing rate might not be important in certain cases if support is on the way, but what if we're performing a triage; we wud have to check breathing rate (among other things), assign a tag and then move on to the next casualty.



a mirror or polished metal surface under the nostrils will show vapor condensation, therefore breathing if you don't want to move the patient


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## bigbaldguy (Mar 22, 2011)

Yeah BGL would have been one of the the first things I checked, but as a basic we can do that here in Texas. Was there any sign of possible drug use? Environmental causes? Condition of the home, type of neighborhood?


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