Fractured NOF

[enjoynz]

Hi All

I would like to know how you package your eldery patients with a fractured NOF (Neck of Femur).
We had one yesterday, and my partner and I were the only one's at the call.
It was interesting trying to get the pt from the floor and onto the cot.
I did notice one thing though. The pt much prefered to lie sitting up slightly,which took the weight off the leg.

Cheers Enjoynz

 

[KEVD18]

well i only bring my x-ray glasses with me to work on odd numbered days of the week. so on the days, hwen i can clearly see they have a neck of femur fracture, i procede with my states very specefic NOF immobilization protocols.

just joshing ya. since we usually cant tell what type or location of fracture a patient has, i immobilize according to moi. traction, lbb, board splint, no splint, press hard three copies you can walk splint, whatever is appropriate.

if you KNOW what type/location of the fx, that probably becuase you had a mobile radiology report right? so the patient is in a nursing home, they fell. staff suspects a fx, but instead of sending them out immediatley, they pick them up(read manhandle them back into bed), call the covering md whos orders an xray. xray tech comes out, shoots the film, develops it and leaves it for the radiologist. he reads it dx's it, writes his note and leaves it for his secretary to fax to the nh. after she eats her salad, smokes to marlboro menthol light 100's and chats to her boyfriend for 30min, she gets back to her desk and faxes the note to the nh. after the nurse finishes her salad, smokes her two marlboro menthol lights, calls her sister in whatever the hell country she came from for 30min and gets back to the desk; finds the report and faxes it to md. repeat process for md's secretary. md gets report, calls nursing home and orders pt to be sent to hospital. nurse calls for ambulance. you get there with your clipboard and your jump bag. so they key question: how long has it been since the incident and much damage has been done. furthermore, if these circumstance ring true for thins call or any other that you ever do, how much more damage are you going to do by going through your various immobilization protocols. im not saying whether or not to do it, just food for thought.

btw, that exact call is one i have done countless times in my career.

 

[enjoynz]

OK, more info needed I see!

I should have said suspected NOF!
The call was to a Medical Alarm activation to a flat, not a rest home.
Pt had been on the floor for approx 30 minutes when we arrived.
(As we were on the way back to town from another job, when the call came through).
On examination, pain was to top of leg, definate shortening of the leg.
Hips were fine!
We don't have access to mobile X-ray units in country towns, in NZ! lol.

Cheers Enjoynz

 

[Ridryder911]

Surgical neck fractures is not a rocket scientist to determine. Palpation of the greater trochanter and into the surgical neck area, with palpation upon the illiac will induce great pain, and even possibly slight movement. It does not take much pressure. Look for rotation of the extremity of externally rotation or internally.

The treatment is usually the same as hip fracture, one can immobilized with new devices such as SAM pelvic splint or similar, and towel, pillows, etc to prevent pressure to be placed upon the area.

Traction splinting is generally contraindicated due to the vascular area (femoral artery circumflexing) and the reason of traction splinting is to prevent the quad's from having spasms, in which surgical neck fractures usually do not present.

One does not have to have X-ray vision, but an assumption after good palpation and assessment.


R/r 911

 

[Ridryder911]

well i only bring my x-ray glasses with me to work on odd numbered days of the week. so on the days, hwen i can clearly see they have a neck of femur fracture, i procede with my states very specefic NOF immobilization protocols.

just joshing ya. since we usually cant tell what type or location of fracture a patient has, i immobilize according to moi. traction, lbb, board splint, no splint, press hard three copies you can walk splint, whatever is appropriate.

if you KNOW what type/location of the fx, that probably becuase you had a mobile radiology report right? so the patient is in a nursing home, they fell. staff suspects a fx, but instead of sending them out immediatley, they pick them up(read manhandle them back into bed), call the covering md whos orders an xray. xray tech comes out, shoots the film, develops it and leaves it for the radiologist. he reads it dx's it, writes his note and leaves it for his secretary to fax to the nh. after she eats her salad, smokes to marlboro menthol light 100's and chats to her boyfriend for 30min, she gets back to her desk and faxes the note to the nh. after the nurse finishes her salad, smokes her two marlboro menthol lights, calls her sister in whatever the hell country she came from for 30min and gets back to the desk; finds the report and faxes it to md. repeat process for md's secretary. md gets report, calls nursing home and orders pt to be sent to hospital. nurse calls for ambulance. you get there with your clipboard and your jump bag. so they key question: how long has it been since the incident and much damage has been done. furthermore, if these circumstance ring true for thins call or any other that you ever do, how much more damage are you going to do by going through your various immobilization protocols. im not saying whether or not to do it, just food for thought.

btw, that exact call is one i have done countless times in my career.

Wow! You know way too much of their personal activities! I agree usually there is a way too long delay, yet again geriatric fractures in a skilled nursing unit is not usually considered an Emergency. Most of these patients are NOT considered surgical candidates and will not be able to have internal fixated devices or even go for surgical repair. Usually most are placed in immobilizers and sent back with analgesics and precautions, never to be healed.

I agree, I hate the 0300 late radiology report to have the patient transported. Again, do you contact the ER Physician or private physician to see if they want to wait? Some will while other may not.

So when Johnny Rescuers come with lights and sirens (blowing through intersections), some may consider a little hasty. Of course, that is when they finally quit playing the X-box and put down that Domino's pizza. Then they will have to get a fresh dip of smokeless tobacco and find their squad jacket that has not been laundered in 3 years, along with their baseball cap. (See everyone can label anyone, a little food for thought)..

R/r 911

 

[KEVD18]

R/r: i take greatg offense to your response!





its sony playstation, chinese food and marlboro lights!