Left shoulder pain, s/p hit by car while driving motorcycle part 2

Authors:

• Elliot Williams, Paramedic Woodburn Ambulance

Editors:

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

Diagnosis

• Left shoulder pain

Editor’s Notes

Teaching points for educators:

• C-spine issues and modern treatment of the same.
• Kerr sign and is this actually internal bleeding?
• Fx vs dislocation (anterior vs posterior dislocation)
• Splinting of the shoulder
• Pain management and the need for at least an IV lock

– David Tauber, Program Director, Yale University Paramedic Program

Suggested References

Kallmann syndrome

Case Details

DISPATCHED TO MC VS CAR ACCIDENT. PATIENT IS 23YOM, RIDER OF MC THAT WAS STRUCK BY A CAR WHILE TRAVELING AT ~20-25MPH FROM THE RIGHT. CAR WAS MERGING ONTO HIS LANE OF TRAVEL IN ROUGHLY THE SAME DIRECTION, PULLED OUT IN FRONT OF HIM AT ROUGHLY A 45 DEGREE ANGLE. PATIENT WAS EJECTED FROM MC AND ROLLED OVER HOOD OF SMALL CAR. SMALL CAR DID NOT STOP, CRASH NOT WITNESSED. PATIENT WAS WEARING A FULL FACE HELMET AND PROTECTIVE JACKET, BUT WAS WEARING SHORTS AND TENNIS SHOES. PMH: COLEMAN’S SYNDROME, ASTHMA. PATIENT DENIES LOC, STATES ONLY COMPLAINT IS LEFT SHOULDER PAIN. DENIES SOB, HEAD NECK OR BACK PAIN. ABD SNT. MAEX4 BUT PAIN WITH LEFT ARM MOVEMENT. MINOR ABRASION AND REDNESS ON LEFT THIGH. REDNESS, BRUISING AND SWELLING ON TOP OF LEFT SHOULDER, PAIN WITH MOVEMENT 7/10, LEFT CLAVICLE STABLE BUT PAINFUL TO PALPATION, SHOULDER FEELS SWOLLEN. MINOR ABRASION LEFT ELBOW. PHYSICAL EXAM WAS OTHERWISE ATRAUMATIC AND UNREMARKABLE. PATIENT REFUSED IV AND PAIN MEDICATIONS. DENIES NAUSEA, HEAD ACHE AT ANY TIME. NO CHANGES EN ROUTE. REPORT TO RN AND MD IN ROOM 11 AT SILVERTON ED. ALL TIMES APPROXIMATE. END OF REPORT.