Often our patients and clients tell 3 stories. The one to get dispatch to send us as fast as possible, the version on scene is never as exotic, then they pepper in a completely new history and chief complaint at triage.
When very lucky, we get a call that evolves in front of our eyes from the mundane to the exotic. In this case it was because of a bystander.
THE EMERGENCY
The caller states her husband has twisted his ankle and is unable to stand.
THE ACTION
Lights and sirens through the pouring rain and we discover the neighborhood parking attendant jumping up and down in the middle of the street waving his arms as if we were the first airplane to fly near his island in years. Conveniently enough he's in front of the reported address so we pull over and go to work.
The injury is straight forward enough and I begin my secondary assessment. He's sitting at the base of a couple of old steep steps and I almost made a big mistake by assuming the steps were the culprit.
"How did this happen?" I ask as the EMT begins to splint the ankle.
"Oh, I lost my balance." He responds, clearly distracted by the discomfort of the splinting efforts.
"Were you dizzy, did the world start to spin?" Now there is a whole new window of concern opening, and quickly.
"Not until after the fall was I dizzy." Or patient answers, occasionally wincing with pain.
"He felt better after he threw up." Says a woman holding an umbrella just out of our little treatment circle.
When I asked about the vomiting he confirmed that soon before the fall down the steps he did indeed vomit, felt dizzy and had to catch his breath.
Needless to say my spider sense was tingling. I was missing something and it was bothering me.
On further questioning we were finally able to patch together what had happened. Are you sitting down?
In the backyard, under a tarp was a table saw. Trying to finish a project before the worst of the storm passes through, our patient failed to use proper precautions against wood resting between the fence and the blade. As the blade spins against the wood, there is a tendency for the wood to stick or kick back. When a small piece of wood became stuck between the fence and the spinning blade he reached for it using a push stick, a god idea, but approached it head on.
The 2" x 4" by about 3" piece of wood struck him square in the chest traveling at least 50mph, knocking the wind out of him. Disoriented and in pain, he stumbled around the front of the house and vomited on the sidewalk, seen by our umbrella lady. Then he tried to get in the side door to call for help, but lost his balance and twisted his ankle.
Then we were called.
He never showed signs of a traumatic injure to his chest, but there it was. And we almost missed it. Imagine THAT triage story coming out at the local ER instead of the regional trauma center.
When very lucky, we get a call that evolves in front of our eyes from the mundane to the exotic. In this case it was because of a bystander.
THE EMERGENCY
The caller states her husband has twisted his ankle and is unable to stand.
THE ACTION
Lights and sirens through the pouring rain and we discover the neighborhood parking attendant jumping up and down in the middle of the street waving his arms as if we were the first airplane to fly near his island in years. Conveniently enough he's in front of the reported address so we pull over and go to work.
The injury is straight forward enough and I begin my secondary assessment. He's sitting at the base of a couple of old steep steps and I almost made a big mistake by assuming the steps were the culprit.
"How did this happen?" I ask as the EMT begins to splint the ankle.
"Oh, I lost my balance." He responds, clearly distracted by the discomfort of the splinting efforts.
"Were you dizzy, did the world start to spin?" Now there is a whole new window of concern opening, and quickly.
"Not until after the fall was I dizzy." Or patient answers, occasionally wincing with pain.
"He felt better after he threw up." Says a woman holding an umbrella just out of our little treatment circle.
When I asked about the vomiting he confirmed that soon before the fall down the steps he did indeed vomit, felt dizzy and had to catch his breath.
Needless to say my spider sense was tingling. I was missing something and it was bothering me.
On further questioning we were finally able to patch together what had happened. Are you sitting down?
In the backyard, under a tarp was a table saw. Trying to finish a project before the worst of the storm passes through, our patient failed to use proper precautions against wood resting between the fence and the blade. As the blade spins against the wood, there is a tendency for the wood to stick or kick back. When a small piece of wood became stuck between the fence and the spinning blade he reached for it using a push stick, a god idea, but approached it head on.
The 2" x 4" by about 3" piece of wood struck him square in the chest traveling at least 50mph, knocking the wind out of him. Disoriented and in pain, he stumbled around the front of the house and vomited on the sidewalk, seen by our umbrella lady. Then he tried to get in the side door to call for help, but lost his balance and twisted his ankle.
Then we were called.
He never showed signs of a traumatic injure to his chest, but there it was. And we almost missed it. Imagine THAT triage story coming out at the local ER instead of the regional trauma center.
Comments
You guys really have to be on your toes, don't you, to get beyond what's directly in front of you, especially under the influence of adrenaline?
Wasn't until lifting his shirt to put him on the monitor that we saw the HUGE bruises right across his sternum.
"Oh, yeah, yesterday I was working out and dropped the bar."
All 220 pounds of it.
On his chest.
Forgot to mention that small detail.