# How about this one?



## mycrofft (Mar 25, 2009)

TV news cameraman is working on a story outdoors, a local entrpeneur is leasing goats and portable fencing for weed control. Backing up, cameraguy falls and hits head on a protruding rebar sticking out of the ground used to stabilize the fences, like a tent stake; has freely bleeding scalp wound and pain galore. They apply first aid, they finish the story, he finishes the day and then checks into the local ER, has bad headache, and it is work related.

End of the week: dead from infection due to penetrating wound from the fall, actually penetrated the scalp, fracured a bit of skull which poked through the dura and sent goat poop and other microbes into the brainbox. Apparently no external issue of CSF or lost in usual mess of hair and blood with suich wounds.

OK, how in the name of little green roadapples could this have been foreseen? (Real case, as reportd by hs station years ago).


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## 2630 (Mar 25, 2009)

foreseeable... probably not but it sounds as though it should have been handled a bit differently.
it would seem that a few things would need to be answered first. you said no signs of csf, what about deformities and crepitice to the area? we have a headache but are we also seeing ANY signs of ams? being work related as well, should he not have been removed from the area and sent to be evaluated by a dr for the possibility of a workers comp claim.
lets look at the area where we fell. contained animals, outdoors and rebar (almost all of the rebar that i have seen is covered in rust and debris, add animals to the mix and it is a germ heaven). was treatment provided by professional ems (gloves and proper bsi), or was it provided by someone who just spent the last hour petting the animals?
er side of things... did they do a ct scan? what meds did they prescribe to fight infection?
in the end, i can maybe see prehospital care missing the penetrating trauma if it small, but the risk of infection was astronaumical and should have been addressed from the very beginning.

2630


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## mycrofft (Mar 26, 2009)

*Initial treatment was first aid by pt and bystanders.*

Apparently he "shook it off" and kept working.
TV cameramen are like jockeys, work is tentative and "softies" don't get the calls to come work. 
My feeling is that this was a sort of "magic bullet" deal, "whoda thunkit?".


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## AJ Hidell (Mar 26, 2009)

mycrofft said:


> My feeling is that this was a sort of "magic bullet" deal, "whoda thunkit?".


I tend to agree.  It's one of those deals where if the the provider had been able to accurately visualize the scenario from the report s/he was given, then the index of suspicion may have been elevated enough to be a little more diagnostically inquisitive.  But really, with the victim shaking it off and downplaying the injury, I can see how this would not happen.  That said, I have to wonder if the nature of the story was mentioned to the physician.  Any mention of animal or livestock exposure in the scenario would have been a red flag to most providers to prescribe prophylactic antimicrobials.  Even cat scratches get that.


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## mycrofft (Mar 29, 2009)

*And how many antibiotics effectively cross the blood brain barrier?*

Probably would have needed intrathecal ABX's if he had survived to be diagnosed.


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## Veneficus (Mar 29, 2009)

How many times has healthcare advocated better to be checked out and be nothing than not to get checked out and it is something?

I agree with magic bullet, but only because first aid doesn't sound like a HCP. Strangely enough I am dealing with scalp wounds this week, and was told by a prof any wound that penetrates through the 3rd layer of the scalp (apanneurotic layer), is a serious threat to life and health. (honestly I didn't know that on tuesday, but thought I would share that.


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## bensley101 (Apr 11, 2009)

Veneficus said:


> How many times has healthcare advocated better to be checked out and be nothing than not to get checked out and it is something?



Too bad insurance companies are run by crooks.

some jobs just train you to tough it out and keep working. Where I work you almost have to argue that you are taking a day off or leaving if something happens. It's asinine.

Then again, I ran my thumb through a table saw and still toughed it out for the day. But I was young and dumb, and have a gnarley scar to show for my efforts. But hey, I made my boss a few extra bucks right?


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## mycrofft (Apr 11, 2009)

*"Of all the things I've ever lost*

I miss my thumb the most".
(Oh, Mommy!!):sad:


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## cprguys (May 19, 2009)

This is why employers should encourage their employees to seek medical attention when they get injured on the job.  No matter how minor it may look.


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## mycrofft (May 20, 2009)

*CPRguy, when I was an official supervisor, I didn't.*

Once, that is.
Actually I did, but I failed to complete the entire workman's comp paperwork on a friday at four PM, the empoyee left and was unavailable until Monday....$6,000 fine for late paperwork on a self inflicted fingertip avulsion slamming a cabinet door.
Oh, he lived.


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## nomofica (May 21, 2009)

DCAP-BTLS!!!!


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## mycrofft (May 21, 2009)

*???????*

?????????:unsure:


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## nomofica (May 22, 2009)

LOL.

Sarcasm. Just pointing out that I don't think they even checked for cranial damage.

Guy falls and hits his head on rebar? Has a massive headache and is really tender at the impact site? There's blood? I would've done some major assessments on his head. From what it sounds like, they didn't do a good job of that.


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## CAOX3 (May 22, 2009)

Advise of the risks, if he refuses, pack it up and on to the next one.

Patients have choices, choices have consequences up to and including death.


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## Afflixion (May 22, 2009)

Given the situation it probably couldn't have been foreseen but I would've figured he received  an antibiotic as a prophylactic given the location of the lac and the object that inflicted the wound. That may just be my reasoning though...


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## mycrofft (May 22, 2009)

*He was never seen by line ("street") EMT's or etc..*

He was part of a two or three person crew, including "air talent", and the ER got him at the end of the day.


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