Log Roll Pelvic Injury

[firetender]

30ish female. fall from a veichle in another town. Family attempted to drive her home...lying on the grass ...screaming...20 on 1-10 ... Cant touch it , no visible signs ...

Now for the question half of ems on scene wants to roll her to her good hip, the other half says the bad hip. eventually palpate it and felt no movement.

This is all about your relationship with the patient.

Once she knows you're NOT going to get her loaded on pain killers, she'll either cooperate or refuse. If she thinks she's going to get pain killers, then she'll go to the hospital but she'll still be a 20! and you'll get nowhere.

(If you should encounter me while I'm drunk, sure, I'd love a little morphine to go with that!)

Her cooperation is key, and if she gave you a 20 when you asked on a 1-10, shame on you for missing a scammer -- especially in the absence of any injuries!

In answer to your question, in the absence of her guidance, log roll on to the unaffected side. If she screams, splint her legs together and tell her this is the last option and she's going to be moved and it'll take a second. Then, do it fast.

Watch how she plays you.

If she's legit, then you will be able to get her to help you move her. I didn't hear anything about a head-to-toe exam, either; a totally inadequate response, primarily because this is the time when you establish rapport with your patient and can enlist their aid to determine just how bad they REALLY are. This is also the time when you establish yourself as the expert.

 

[reaper]

So she a drug scammer, just off that little bit of info? Nice way to play god over people!

 

[CAO]

Drat. I thought this was a chance to rig something up and test our ingenuity.

I could already hear the MacGyver theme in my head.

 

[firetender]

Aloha, Reaper, long time no scuffle!

So she a drug scammer, just off that little bit of info? Nice way to play god over people!

I presented a process of elimination with focus on the patient first. Her cooperation would help me ascertain if my initial "hit" was correct or not.

If I smell poop on entry to the scene I'm going to glove up and then do my work. Since textbooks don't talk about putting telltale signs together to recognize the POTENTIAL for abuse, then we need to cover it here.

And, as usual, key components of the narrative were missing, like "Um, how did you get here on the ground, Ma'am?" Once again, a scenario lacking in details adequate to make a determination.

...and actually, if you look at my approach, I give her the first nod by enlisting her aid. Were I God, I would just act like she was a junkie. I proposed acting like she was a real human being.

Outside of all that, howzit?

 

[Shishkabob]

I'm not of the "wait for drugs on board before moving" crowd. I'm of the move the move them quickly and hopefully that relieves some, if not most of the pain, than go from there.

If you leave them on the ground without trying to reposition them, they're in that pain that much longer just waiting on the drugs to kick in...which won't have their full effect for a while.


I had a relatively similar scenario a few months ago and we quickly moved the guy to the cot, and it helped immensley with the pain. When we got him to the rig I gave him all the opiods he coukd handle to help with the rest of the pain.





But to answer the ops question, you roll to the good side, baring any extenuating factors. The hip is obviously unstable as is, so putting a ton of weight on it isn't really that good.

 

[Aidey]

I have to admit that the thought of drug seekign definitely crossed my mind too, sorry if that makes me a horrible person, oh well.

As for the wait for opiates thing, I'm not saying don't do anything else in the meantime. I'm thinking more of the cases where the situation won't allow for a quick move.

 

[TransportJockey]

I changed my mind on how to deal with this patient. Scoop, vec, roc, tube, vent, call Brown in his orange 'DOCTOR' jumpsuit

 

[LonghornMedic]

Id use a scoop stretcher.

Bingo!

 

[the_negro_puppy]

I changed my mind on how to deal with this patient. Scoop, vec, roc, tube, vent, call Brown in his orange 'DOCTOR' jumpsuit

x2 on Brown backup

 

[MrBrown]

*Brown and Oz swan down out the sky in thier "DOCTOR" jumpsuits and look around wondering if Puppy has called Dr Rashford (the QAS Medical Director) and prepare to either treat the patient or fight to the death with Dr Rashford for the job

Put in a line, bit of morph and if that don't work top her off with some ketamine, off to hospital, nice and easy .... can probably be taken by road.

Gah Oz, the things they are calling us for these days! ... oh and JT you have to anaesthetise the patient first before you give them vec and roc, no "DOCTOR" jumpsuit for you

 

[usalsfyre]

I presented a process of elimination with focus on the patient first. Her cooperation would help me ascertain if my initial "hit" was correct or not.

If I smell poop on entry to the scene I'm going to glove up and then do my work. Since textbooks don't talk about putting telltale signs together to recognize the POTENTIAL for abuse, then we need to cover it here.

And, as usual, key components of the narrative were missing, like "Um, how did you get here on the ground, Ma'am?" Once again, a scenario lacking in details adequate to make a determination.

...and actually, if you look at my approach, I give her the first nod by enlisting her aid. Were I God, I would just act like she was a junkie. I proposed acting like she was a real human being.

Outside of all that, howzit?

And if the patient is seeking, you've harmed them by giving meds how? As opposed to the patient who really is in pain that you've withheld from and now has to lay there in pain because her paramedic thinks he's "Narcoman: Defender of the Opiates"...

Why are people more concerned with being fooled than pain itself?

 

[usalsfyre]

First choice, c-spine clearance, second choice scoop, third choice, straight lift to a board and finally log roll on the good side to a board. Don't aggravate the injury by making the patient lay on it, no matter how brief a time period.

 

[LonghornMedic]

And if the patient is seeking, you've harmed them by giving meds how? As opposed to the patient who really is in pain that you've withheld from and now has to lay there in pain because her paramedic thinks he's "Narcoman: Defender of the Opiates"...

Why are people more concerned with being fooled than pain itself?

Exactly. Give them meds. That's what you are there for. I'd rather give pain meds to 100 drug seekers than end up missing one legitimate patient in pain.

 

[Veneficus]

Arrived on scene to find a 30ish female. She had a fall from a veichle in another town.

As in car surfing, riding in a truck bed? Suspicious circumstances you are not being told?

Family attempted to drive her home. Got as far as our district.

The home boy ambulance service, gotta love 'em.

Partner and I find her lying on the grass on the side of the road screaming in pain. Chief cmplaint a 20 on 1-10 pain scale for right hip area. Cant touch it , no visible signs of fracture, dislocation, bruising, bleeding or swelling.

So call ALS or if you are, give her some drugs, splint her, scoop or slide her vertically on a board, load her up and transport. A rather straight forward case.

We acess her, manual c-spine, collar and backboard her..

Why did you decide to do this? (can't offer an opinion with what is listed here)

Now for the question half of ems on scene wants to roll her to her good hip, the other half says the bad hip. Which way would you go? I'll tell you what we did and why. But need to know what you think.We did eventually palpate it and felt no movement.

Textbook says to roll on the good hip. But there is more than one way not to roll her at all. (clearly covered in the responses already)

I would suggest reducing the pelvis before moving. You know, splinting helps reduce secondary injury and often reduces pain.

From your very meager description, if ALS is available, call them.

Before we start to decide who should receive pain medication and who shouldn't, we need to consider the injury. Bad people get hurt too, that incldes addicts.

From a personal standpoint, since EMS isn't prepared to offer an addict the level of help they need, they shouldn't be deciding a seeker shouldn't get meds. If all you do is withold pain meds for a one time event, what good are you doing the patient? In healthcare try not to let social bias influence medical decision making. It is not your job, duty, or whatever to administer what you decide as justice. All patients are worthy of your best and the best you can offer. (granted depending on the level of fatigue, etc, your best is always relative, but it should never include a holier than thou attitude.)

US EMS education doesn't include any depth of knowledge, adding social implication to that may be a little much.

"Man up" is not good medicine. Always bear in mind the standard of care. You are always responsible to it.

 

[firetender]

you are not being told?

(can't offer an opinion with what is listed here)

From your very meager description,

Before we start to decide who should receive pain medication and who shouldn't, we need to consider the injury. Bad people get hurt too, that incldes addicts.

From a personal standpoint, since EMS isn't prepared to offer an addict the level of help they need, they shouldn't be deciding a seeker shouldn't get meds. If all you do is withold pain meds for a one time event, what good are you doing the patient? In healthcare try not to let social bias influence medical decision making. It is not your job, duty, or whatever to administer what you decide as justice. All patients are worthy of your best and the best you can offer. (granted depending on the level of fatigue, etc, your best is always relative, but it should never include a holier than thou attitude.)

Always bear in mind the standard of care. You are always responsible to it.

Based on the OPost and follow up; I'm skeptical that there's any injury whatsoever. There was really only one question (Logroll on which side first) when there should have been many.

Once again, a process of elimination with the nod ultimately going to the patient and ALL based on the circumstances. Nowhere did I say "withhold" treatment of valid injury. Find me one first; that's your job.

 

[Pittma]

Well here's my best shot- like it was already said if she's seeking, well, she's seeking. But who am I to decide what's too much pain for the girl? I probably would have done what someone already said, though. I would have told her we were going to roll her on her good hip- and prepared to do it quick. If she wouldn't tolerate any movement, we could lift her up about 3in and get the LSB in, but obviously I would rather get the scoop (scenario says we don't have one though). As a newbie, I would assume C-Spine based on the MOI, I mean, doesn't it take a good amount of force to break a hip? If she was intoxicated, she probably wouldn't have known if she had a broken neck or anything (although slim chance if she got back in the car and drove for a bit), but what's wrong with the extra precaution? Would it be wrong to assume C-Spine? Other than that, I'd try to make her as comfortable as possible on a board, splint it on the way to the hospital, and treat her like any other patient- drug seeker or not.

 

[Veneficus]

Nowhere did I say "withhold" treatment of valid injury. Find me one first; that's your job.

Maybe I am jumping to an unfair conclusion, but from the description here, I am suspect of the quality of the exam and efforts.

In all fairness to the OP and collegues, Basics are specifically told not to perform a specific test that yields results. (specifics witheld so nobody takes it upon themselves to deviate) Based also on the question, it sounds like they are too inexperienced to press hard enough even when it hurts in order to find what is there. Just my thoughts.

 

[usalsfyre]

Based on the OPost and follow up; I'm skeptical that there's any injury whatsoever. There was really only one question (Logroll on which side first) when there should have been many.

Once again, a process of elimination with the nod ultimately going to the patient and ALL based on the circumstances. Nowhere did I say "withhold" treatment of valid injury. Find me one first; that's your job.

Why are you so skeptical? What is considered a "valid" (I read "worthy") injury? And I ask again, what are you out if they are seeking?

 

[usalsfyre]

As a newbie, I would assume C-Spine based on the MOI, I mean, doesn't it take a good amount of force to break a hip? If she was intoxicated, she probably wouldn't have known if she had a broken neck or anything (although slim chance if she got back in the car and drove for a bit), but what's wrong with the extra precaution? Would it be wrong to assume C-Spine?

Never assume anything based on "mechanisim". MOI was meant to help determine what injuries might be present, not to BE the assesment. If I apply an massive amount of force solely to your femoral neck and break your hip, do you think it would damage your spine?

Everyone, intoxicated or not I have ever seen with a spinal injury has been soley concerned with their back and/or neck. Granted, this is not scientific, YMMV ect, ect.

 

[Pittma]

Never assume anything based on "mechanisim". MOI was meant to help determine what injuries might be present, not to BE the assesment. If I apply an massive amount of force solely to your femoral neck and break your hip, do you think it would damage your spine?

Everyone, intoxicated or not I have ever seen with a spinal injury has been soley concerned with their back and/or neck. Granted, this is not scientific, YMMV ect, ect.

Right, but we don't know that the force was applied solely to the hip, and I guess I'm just using the MOI to state not the assessment (which, I would still do anyway), but to show that a large amount of force has been applied to the patient regardless, and though my assessment may find no broken spine or neck, I am not an x-ray machine, and if someone fell out of a car and broke their hip couldn't I assume that (even if my assessment didn't physically feel it upon palpation) enough force was applied that there is still a risk, and precautions can be taken? I'd rather take the precaution than have to explain why I didn't take precautions, right?