Did I make a mistake on this call?

Fezman92

Fezman92

NJ and PA EMT
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So as I said in the directionless thread, I finally had my first call as the treating EMT and it was interesting. 31y/o male, with a possible right femur fracture. Since PT had paralysis (previous history), there was no pain, but they were shaking and diaphoretic, which according to the PT, it was his body's way of letting him know that something was wrong (as if the 'snapping sound like a twig' and obvious deformity, swelling, and odd positioning of the leg didn't give it away). Even my partner who has been doing this for a while never encountered a PT like this before. Annoyed at myself that I couldn't get a BP though. My question is should we have splinted? His legs were contracted and he wasn't in any pain, so my partner didn't think we needed to and I felt uncomfortable disagreeing with him since he was the squad EMS chief.
 
I would've splinted it. Even though he doesn't feel pain, you want to prevent it from moving and causing further damage. Kinda sounds like autonomic dysreflexia to me, if he has paralysis due to a prior spinal cord injury.

Check out "crew resource management" (CRM) Don't feel uncomfortable speaking up. Be polite and direct. You guys are a team and you're there to help the patient. You're not challenging the squad EMS chief, you're just looking out for the patient. Just say it politely. It's a splint. No reason to be offended.
 
How could it have been autonomic dysreflexia? He said that he heard a snap and there was obvious deformity and when you palpated, it was obvious that something was out of place. I couldn’t get a BP because the ambulance was on a very bumpy road and he was shaking a lot.
 
How were the ankle, knee, and hip? Stable? Isolated femur fracture with deformity.Traction splint. Any problem anywhere else, splint in place.

BP in moving, bumpy vehicle is tricky. Keep practicing. If you were concerned about it being hypotensive, have your partner stop for a minute to get your baseline vitals, or do one set on scene.

Every call will let you learn something. It gets easier.
 
Fezman92 said:
How could it have been autonomic dysreflexia? He said that he heard a snap and there was obvious deformity and when you palpated, it was obvious that something was out of place. I couldn’t get a BP because the ambulance was on a very bumpy road and he was shaking a lot.
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This part of what you said

Since PT had paralysis (previous history), there was no pain, but they were shaking and diaphoretic, which according to the PT, it was his body's way of letting him know that something was wrong
Click to expand...
 
thanks 😊
 
Did you transport?
Did he live?
There you go.

Stop second guessing every move you make.
 
Splint yes, but I think a traction splint here is more trouble than it's worth due to contractures, depending on severity.
 
I did try to palpate a BP. I'll have to practice it at home.
 
Fezman92 said:
So as I said in the directionless thread, I finally had my first call as the treating EMT and it was interesting. 31y/o male, with a possible right femur fracture. Since PT had paralysis (previous history), there was no pain, but they were shaking and diaphoretic, which according to the PT, it was his body's way of letting him know that something was wrong (as if the 'snapping sound like a twig' and obvious deformity, swelling, and odd positioning of the leg didn't give it away). Even my partner who has been doing this for a while never encountered a PT like this before. Annoyed at myself that I couldn't get a BP though. My question is should we have splinted? His legs were contracted and he wasn't in any pain, so my partner didn't think we needed to and I felt uncomfortable disagreeing with him since he was the squad EMS chief.
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What an interesting first call. First of all, I understand the difficulty you had with standing up to your EMS chief. I would have done the same if something happened like this on my first call ever. However, you have to remember that the patient always must come first. Then you have to remember that if the patient decided to sue for negligence in the future, you could be held responsible as a provider on scene. With your partner having seniority over you, he may have refused to splint even if you brought it up, but mentioning in your report that you at least said something or tried to splint the patient will protect you in the courtroom.

Clinically, yes, the patient should have been splinted. What is the life threat with a femur fx? The femoral artery. If that artery were to be compromised, many issues could arise. At best, the artery could be pinched and the pt could lose blood supply to the leg. At worst, the artery could be punctured from the femur fx, which would cause the pt to bleed out quickly. Keep in mind your ABC's on every call.

Victoria
 
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