Hip Pain S/P Ground Level Fall


• Scene – IV 20g, 50mcg fentanyl, position of comfort

• En route – 50mcg fentanyl (100mcg total), IV fluids @ 250ml/hr

• Hospital – X-ray Disposition

• Response to treatment – Pain improved significantly with fentanyl.

• Disposition – Patient was diagnosed with a contusion, no fractures or dislocations noted.


Elliot Williams, Paramedic Woodburn Ambulance


David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center


• Ground level fall (GLF)
• Hip contusions

Differential Diagnosis

• Working DDx – r/o hip, pelvis, femur FX, dislocation, muscle/soft injury

Patient Workup History

• Patient states – she tripped and fell on the floor molding on her new kitchen floor.

• States extreme pain with any movement.

• Denies dizziness before the fall but noted some after.

• Denies nausea, chest pain, shortness of breath.

• No head, neck or back trauma; injury isolated to hip.

Physical Exam

• No shortening or rotation

• No deformities to R hip

• Pelvis stable to rocking

• GCS – 15

• EKG – sr

• CBG – 100

Suggested Approach Notes

• 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: 69 years

• Height: Not Available

• Weight: Not Available


• Temperature: Not Available

• Blood Pressure: 124/74

• Heart Rate: 66

• Respiratory Rate: Not Available

• Pulse Oximetry: 99% RA

Signs and Symptoms

R hip pain; painful range of motion

History Medical

• PMH: Intestinal bypass surgery 30+ years ago; heart murmur; depression, breast augmentation.

• Allergies: Valium causes seizure

• Dispatch information: Fall victim with hip pain.


• Fully independent


• Vicodin 5/325, Effexor, Trazadole, Prilosec, calcium, vitamin D, thyroid, Evista

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