Called for a Fall

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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
 
Out here a BLS truck would have gotten a CBG. Why the 10LPM? A N/C at 4 probably would have worked just fine.
 
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
 
Capillary Blood Glucose. Also known as BGL
 
Blood Glucose Checks are not in my scope of Practice in PA, its a very archaic basic system
 
Seriously! ?you are not allowed to check blood sugar level. Wow.:o
 
foxfire said:
Seriously! ?you are not allowed to check blood sugar level. Wow.:o
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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.
 
Why was a basic truck transporting this patient?
 
Aidey said:
Why was a basic truck transporting this patient?
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Dispatched as a Bravo (Non-Life Threatening) Fall. Basic Trucks can get Alpha and Bravo (lowest priority) calls in my area.
 
What did your head-to-toe trauma assessment yield? Any particular findings?

PMHx or a medication list?

Baseline mental status per the brother?
 
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.
 
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.
 
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?

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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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?
 
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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ALS for:

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

Hopefully a thorough assessment (pupils anyone?)

Sorry, Equal and Reactive

Blood sugar check, and treatment if needed
EKG & IV. Patient is a candidate for rhabdo.
Click to expand...

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