• Scene – C-collar, assessment, vitals, EKG
• En route – IV, O2, CBG, secondary assessment, detailed
• Hospital – CT-scan
• Response to treatment – pt did respond to O2.
• Disposition – pt uses a walker to ambulate at the retirement center where she lives. She has had an increase in her morphine dose, and now takes morphine 3x/day (30mg), and also has a lidocaine patch (unk dose).
•Professor of Pediatrics
• Ground level fall (GLF)
This patient did not have any pain complaints in her neck or back; her pelvis was stable. No head trauma was noted; no marks at all. En route pt complained of headache that got worse with time. Pain was described as dull and throbbing.
-Mark Shelton, Paramedic
• 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.
Headache worsening with time