Multiple injuries s/p fall


• Scene – C-collar, EKG, IV
• En route – 125ml IV fluids; refused pain medications.
• Hospital – unknown


• Response to treatment – pain was 0 on scene before moving patient to the cot, 8/10 after moving. Refused pain medication. Did not tolerate LBB. No significant change in BP after fluid bolus.


• Elliot Williams, Paramedic Woodburn Ambulance
• David Jones, MD Oregon Health and Science University


• David M. Spiro, MD, MPH Professor of Pediatrics University of Arkansas Medical Center
• Ritu Sahni, MD, MPH Oregon Health & Science University

• Closed head injury
• Traumatic injury

Differential Diagnosis

• Hyperglycemic event dka r/o
• Multiple falls caused by undiagnosed peripheral neuropathy.
• Hypotension
• CVA r/o
• Cardiovascular r/o

Patient Workup

• Patient states she got weak and dizzy and then things “went black.” Reports chest pain prior to fall. Pain 8/10 thru/o.
• Caregiver states another resident heard her fall, called for help. Staff found her down in kitchen trying to get up. They assisted her back into bed and later called 911. Staff states 2 falls earlier last week.

Physical Exam

• Multiple wounds in various stages of healing
• Head abrasions
• No deformities or tenderness of neck, back or pelvis
• GCS – 15

Suggested Approach

• In bleeding patients, try and control the bleeding as soon as possible. The scalp is a very vascular area, and patients can lose a lot of blood very quickly from a scalp wound.
• Make sure to ask about aspirin (salycilate), Plavix (clopidogrel), Coumadin (warfarin), Pradaxa (dabigatran), or other blood thinners the patient may be on. Blood thinners increase the risk of life-threatening bleeds. In a patient like this, the blood thinners may make it hard to control the scalp bleed.
• Patients with histories of dementia may seem very sharp, but this is not always the case. You should be extra cautious about looking for injuries and monitoring for clinical deterioration in patients with dementia.
• Even patients who seem like they are mechanical falls should get an EKG, stroke screen and blood glucose level. Cardiac ischemia or stroke could masquerade as a mechanical fall, and if you don’t look you’ll never find the real cause of their fall.
• Low mechanism injuries can also lead spinal injuries in the elderly. The spine should be carefully examined and any indication of possible injury should lead to proper spinal precautions (which varies by local protocol).

Suggested references

• Falls in the elderly


• Gender: Female
• Age: 73 years
• Weight: Not Available


• Temperature: Not Available
• Blood Pressure: 104/46
• Heart Rate: 65
• Respiratory Rate: 18
• Pulse Oximetry: 97% RA
Signs and Symptoms
Multiple wounds and abrasions


• Cardiovascular disease; diabetes; hypertension; dementia.
• Dispatch info: GLF, hit head
• Lives at assisted care facility


• NTG, atenolol, glipizide, Tylenol, isosorbide, ASA

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