Back pain, sp fall; interesting finding in patient’s home part 4


• Scene – EKG, VS
• En route – IV 20G,TT, fluids (311ML), CBG, 12 lead, oral fluid 250 ML
• Hospital – unknown


• Response to treatment – no changes
• Disposition – unknown


• Elliot Williams, Paramedic Woodburn Ambulance
• Matthew Hansen, MD Oregon Health & Science University


• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Mohamud Daya, MD Professor Oregon Health & Science University
• Toni Grimes, EMT-P Woodburn Ambulance

• High blood pressure
• Fall
• Failure to thrive
• Ground level fall (GLF)
• Trail house (garbage house)

Differential Diagnosis

• Ground level fall (GLF)
• Hypertension
• Dehydration
• Failure to thrive
• Pelvis fracture
• Back contusion
• Fracture of the spine
• CVA/stroke

Patient Workup

• Patient states – She fell at 0410 and had to crawl to another room to push her medical alarm button. Patient states that she hit her back on a piano stool and had some back pain on scene, but not en route.

Physical Exam

• GCS – 15
• CBG – 97
• Back pain; no marks or trauma noted to back
• Arthritis hands and feet

Editor’s Notes

This was a trail house, as seen on video footage. Footing was very sketchy even for us, let alone the patient. It’s unlikely the patient is able to cook meals in her kitchen due to its condition. We advised the RN at the hospital of the patient’s living condition, and recommended that health services be contacted. Patient admits to not drinking enough fluids; she has normal urination and chronic constipation. -Mark Shelton, Paramedic on scene; Woodburn Ambulance Service

Suggested Approach

• The algorithm for trauma stabilization in the elderly is similar to that for younger patients with a few extra cautions. Generally speaking, the approach should be more conservative than for younger patients. For example, the existing cervical spine clearance protocols have not been studied in the elderly, so “clearing” the cervical spine in an injured elderly patient usually requires imaging and should not be done in the field. Elderly patients with seemingly minor injuries in the initial assessment may be hiding significant injuries such as fractured ribs, intracranial hemorrhage, or a fractured pelvis.
• Elderly patients suffer much higher morbidity and mortality from trauma, so providers should take care in not under-triaging elderly patients and consider transporting elderly patients to trauma centers though the injuries may not initially seem significant. A brief AMPLE (allergies, medications, past history, last meal, and events) history should be taken with focus on potential anticoagulant use, insulin use, and cardiac medication use.
• GLF are common, therefore it is important to decipher 2 things on scene and en route: 1) why the person fell, and 2) consequences of the fall. Many factors contribute to the “why”: Lost balance and agility due to aging, medication side effects, loss of postural tone, occult bleeding (GI or retroperitoneal), dysrhythmia, acute coronary syndrome, TIA, dehydration, and other factors all can lead to near syncope or syncope. EMS personnel must put thought into the cause as well as the consequence.

Suggested references

Falls in the elderly


• Gender: Female
• Age: 84 years
• Height: Not Available


• Temperature: Not Available
• Blood Pressure: 165/84
• Heart Rate: 96
• Respiratory Rate: 14
• Pulse Oximetry: 95% RA
Signs and Symptoms
Back pain, ground level fall (GLF)


• Arthritis, hypertension, breast cancer.
• Allergies: None
• Dispatch info: Unknown medical alarm


• Lives alone


• Losartin; Diovan HCT

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