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Home > List Archives

Consider this Case Study

trauma-list@trauma.org trauma-list@trauma.org
Fri, 21 Jun 2002 09:58:49 EDT


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In a message dated 05-Jun-02 13:58:26 Central Daylight Time, 
dinerman@computron.net writes:


> 
> Case in point regarding vascular Doppler in the field:
>  
> On my last shift I attended a 34 y/o male bicyclist who, while on his 
> customary pre-dawn ride,  hit a hard to see gate and fell on his extended 
> right arm. He was rewarded with a severely angulated, fractured / 
> dislocated right elbow. (Probably snapped the humeral head off).  He was 
> wearing his helmet tho.  (Said he bikes for his health!)  
>  
> Cleared C-spine according to our protocol, discovered no other notable 
> injuries during the full exam,(some minor road rash / lacs) splinted the 
> arm from shoulder to fingertips (no radial pulse was noted before or after 
> splinting), moved him to the rig, started IV NS for analgesia, administered 
> 4 mg Morphine for pain, obtained vascular Doppler of distal fingertips 
> indicating circulation present, transported to local ED.  Local ED MD 
> confirmed Doppler, and diagnosis via x-ray. Local ortho and vascular 
> specialists were contacted and Pt was transferred from local ED to Houston 
> (75 miles) for open reduction at a specialist ortho hospital.  
> 

Catching up with the list after a long spell of not being able to read in 
detail...

Just out of curiosity, how did you clear this patient's C spine clinically, 
since he had a significant distracting injury as well as a significant 
mechanism of injury? Any scuff marks on the helmet? IIRC, all of the current 
protocols specify that patients with both of those factors (mechanism and 
distracting injury) should *not* be cleared in the field.

Got bit on that one a long time ago, with a gal who had a dislocated shoulder 
from a 4 wheeler wreck. Turned out that the pain in the shoulder was masking 
neck pain, and follow up films were suspicious for a posterior fracture.

We weren't able to do CT at that hospital that weekend, so had to ship her 
off...I suspect that there was no significant sequelae, as she was lost to 
follow up, but it did get my pulse to rise for a bit.

ck

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<HTML><FONT FACE=arial,helvetica><FONT  COLOR="#408080" SIZE=2 FAMILY="SANSSERIF" FACE="Arial Black" LANG="0"><I>In a message dated 05-Jun-02 13:58:26 Central Daylight Time, dinerman@computron.net writes:<BR>
<BR>
</FONT><FONT  COLOR="#000000" style="BACKGROUND-COLOR: #ffffff" SIZE=2 FAMILY="SANSSERIF" FACE="Arial" LANG="0"></I><BR>
<BLOCKQUOTE TYPE=CITE style="BORDER-LEFT: #0000ff 2px solid; MARGIN-LEFT: 5px; MARGIN-RIGHT: 0px; PADDING-LEFT: 5px"><BR>
</FONT><FONT  COLOR="#000000" style="BACKGROUND-COLOR: #ffffff" SIZE=2 FAMILY="SCRIPT" FACE="Comic Sans MS" LANG="0">Case in point regarding vascular Doppler in the field:<BR>
 <BR>
On my last shift I attended a 34 y/o male bicyclist who, while on his customary pre-dawn ride,&nbsp; hit a hard to see gate and fell on his extended right arm. He was rewarded with a severely angulated, fractured / dislocated right elbow. (Probably snapped the humeral head off).&nbsp; He was wearing his helmet tho.&nbsp; (Said he bikes for his health!)&nbsp; <BR>
 <BR>
Cleared C-spine according to our protocol, discovered no other notable injuries during the full exam,(some minor road rash / lacs) splinted the arm from shoulder to fingertips (no radial pulse was noted before or after splinting), moved him to the rig, started IV NS for analgesia, administered 4 mg Morphine for pain, obtained vascular Doppler of distal fingertips indicating circulation present, transported to local ED.&nbsp; Local ED MD confirmed Doppler, and diagnosis via x-ray. Local ortho and vascular specialists were contacted and Pt was transferred from local ED to Houston (75 miles) for open reduction at a specialist ortho hospital.&nbsp; <BR>
</BLOCKQUOTE><BR>
</FONT><FONT  COLOR="#408080" style="BACKGROUND-COLOR: #ffffff" SIZE=2 FAMILY="SANSSERIF" FACE="Arial Black" LANG="0"><I><BR>
Catching up with the list after a long spell of not being able to read in detail...<BR>
<BR>
Just out of curiosity, how did you clear this patient's C spine clinically, since he had a significant distracting injury as well as a significant mechanism of injury? Any scuff marks on the helmet? IIRC, all of the current protocols specify that patients with both of those factors (mechanism and distracting injury) should *not* be cleared in the field.<BR>
<BR>
Got bit on that one a long time ago, with a gal who had a dislocated shoulder from a 4 wheeler wreck. Turned out that the pain in the shoulder was masking neck pain, and follow up films were suspicious for a posterior fracture.<BR>
<BR>
We weren't able to do CT at that hospital that weekend, so had to ship her off...I suspect that there was no significant sequelae, as she was lost to follow up, but it did get my pulse to rise for a bit.<BR>
<BR>
ck</I></FONT></HTML>

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