Just today the town next to mine toned us for a medic. The call was a 22 year old male who fell at a golf course with a possible dislocated knee. Keeping in mind that our dispatch gives us crap information half the time, why is this an ALS call? Is it just for pain management?
Als/bls
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Most likely pain management, yes. Is that a bad thing?
lawndartcatcher
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What did they fall from? A standing position? A golf cart? The top of a 30 foot ladder?
"just" pain management is a pretty big deal when it's your patella that's been moved 90 degrees from where it's supposed to be. There's also the side benefits of analgesia - to wit, muscle relaxation (reduces local spasm) and mild sedation.
I sympathize with the dispatch situation - I think almost every service struggles with that. The last three cardiac arrest calls I've been to were dispatched as "difficulty breathing". So it's probably not a bad idea, especially if your intercept is coming from some distance away, to get them rolling while the BLS crew triages and stabilizes.
"just" pain management is a pretty big deal when it's your patella that's been moved 90 degrees from where it's supposed to be. There's also the side benefits of analgesia - to wit, muscle relaxation (reduces local spasm) and mild sedation.
I sympathize with the dispatch situation - I think almost every service struggles with that. The last three cardiac arrest calls I've been to were dispatched as "difficulty breathing". So it's probably not a bad idea, especially if your intercept is coming from some distance away, to get them rolling while the BLS crew triages and stabilizes.
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If the pt truly dislocated their knee I would sure hope they got pain management.
Most people only dislocate their patella.
I have seen a truly dislocated knee joint once while working in EMS, the mechanism was so strange, I doubt it could be reproduced by accident.
The patient purposefully wedged her leg between a couch and a wall to attempt to gain enough leverage to open an old house window that when it actually worked opened sideways towards the wall.
With her one leg wedged she twisted her waist, and her knee dislocated and the rusty old window stayed shut.
When I called in to medical control for permission to use more than 10mg of morphine they told me "no" on the phone because I obviously didn't know what I was looking at and it was probably just the patella dislocated.
When I got to the ED, there was much apologizing to both me and the patient. Lunch also miraculously arrived at the station the next few shifts.
After that incident I never remember medical control telling me "no" even when I asked to sedate a psych patient with mag sulfate.
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Even a patella dislocation is a good candidate for pain management.
As an aside, there are only a few things at the sports medicine job where 911 is called immediately, total knee joint dislocation is one of them.
As an aside, there are only a few things at the sports medicine job where 911 is called immediately, total knee joint dislocation is one of them.
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Thankfully I have not seen any of them, even my boss who has 10 years of Division 1 experience has never had one either. The last one as a department we had was with a lineman during a football game (we no longer have football), happened in the pile. I imagine some sort of leverage with another player being the fulcrum likely caused it.
That's how my patella dislocation happened. Hurt like hell. I can only imagine what a total knee dislocation feels like.
Aidey
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I've seen two. Wildland hotshots + mountain goat terrain.
Our medical director advised that in the course of the exam if the patella just happened to relocate, well...oh well.
There are several reasons call could have been upgraded to ALS. Pain management is probably the most likely. Maybe the fall was from a height and protocol states ALS be dispatched. Maybe the fall was a result of an underlying medical condition.
There is no such thing as JUST pain management. Pain can be horrible and noone likes to be suffering. When I was 9 I was helping my grandpa build a house and I fell off some scaffolding and landed directly on my left knee. Fortunately nothing was broken but it was the worst pain of my life. To this day I have knee issues. I can only imagine what someone with a dislocate knee would feel.
I wish at the BLS level there would be something I could do for pain, especially when ALS isn't available, but unfortunately there isn't much.
I am assuming you weren't on the call.
Bullets
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Im with you on this, especially when ALS releases to BLS with a casual, "they're just in pain, you dont need us..."
I have actually seen a total knee dislocation, and it was also something so totally unique that ill probably never see it again. Guy was on a roof and stepping off onto a ladder facing forward, away from the ladder, slipped and his right foot went between the rungs, as he fell his knee hyperextended and he twisted, his right toes were touching the outside of his right thigh.
He got a lot of pain meds