Left shoulder pain s/p fall off motorcycle


• Scene- LBB, C-collar, NRB 02 15LPM
• En route- 18g IV, fluids (700ml given total), 100mcg, 50mcg, 50mcg fentanyl = 200mcg fentanyl total.
• Hospital- Exam, CT scan, unknown further


• Response to treatment – Responded well to pain medications but any movement still painful.
• Disposition – Report to trauma team


• Elliot Williams, Paramedic Woodburn Ambulance
• Matthew Hansen, MD Associate Professor Oregon Health & Science University
• David Sheridan, MD Associate Professor Oregon Health and Science University


• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Toni Grimes, EMT-P Woodburn Ambulance

• Clavicle fracture

Differential Diagnosis

• Shoulder dislocation
• Humerus fracture
• Pneumothorax
• Flail chest
• Clavicle fracture
• Pelvis fracture
• Myocardial contusion

Patient Workup

• Patient states – Speed wobbles caused him to crash at over 100mph. No LOC, only complaint is L shoulder.

Physical Exam Findings:

• GCS – 15
• EKG – sinus
• CBG – 138
• Deformity to L clavicle
• Mild brusing
• Abrasions on hips
• Small abrasions to L knee and L hand
• Skin very diaphoretic
• Patient was relatively uninjured for such a high-speed crash

Editor’s Notes

This crash occurred at a designated drag strip, not on highway or city streets. People who crash going 100mph on the streets are never this uninjured. -Elliott Williams, Paramedic on scene; Woodburn Ambulance Service

Suggested Approach

• Identify and treat life threatening injuries in any trauma patient.
• If a patient is alert and talking, taking a brief history with the mnemonic SAMPLE is helpful; S-situation, A-allergies, M-medications taken, P-past medical history, L-last meal eaten, E-events surrounding current situation. The evaluation consists of a primary and secondary evaluation.
• Although this patient has a stable blood pressure, obtaining IV access is important as he most likely will need pain medications and possibly fluid resuscitation.
• After ensuring their airway is intact and the patient does not need to be intubated, move to the secondary survey, which is an overall exam to identify other injuries. With this mechanism of injury, regardless if the patient has neck pain/tenderness or not, they should be placed in a C-collar and on a backboard to immobilize their spine.
• Make sure to obtain a baseline GCS to evaluate during transport if there are any objective changes in the patient’s mental status.

Suggested references

• Visiting Skid Row


• Gender: Male
• Age: 51 years
• Height: Not Available


• Temperature: Not Available
• Blood Pressure: 117/70
• Heart Rate: 100
• Respiratory Rate: 22
• Pulse Oximetry: 98% RA

Signs and Symptoms

L shoulder pain; multiple bruises and abrasions


• Mitral valve prolapse; “decreased lung function”
• Dispatch info: Motorcycle crash 100mph; rider down


• Married


• None

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