Shoulder trauma, s/p “rollover” motor vehicle accident part 2


• C-Collar and spinal precautions considered but not utilized based on current agency protocols
• Scene – IV, VS
• En route – Fentanyl 50mcg twice, Oxygen 2lpm Cannula
• Hospital – Fentanyl, X-ray, Unk further


• Response to treatment – Patient had slight decrease in pain with fentanyl from 7 down to 6 with 100mcg, sat improved to 98% with oxygen.
• Disposition – Not known


Elliot Williams, Paramedic Woodburn Ambulance


• MVC rollover
• Shoulder pain

Differential Diagnosis

• Trauma entry, R/O fx, dislocation
PIC- Lara Forste Paramedic Partner- E. Williams Paramedic Date 8/19/15

Patient Workup Objective

• Patient states- She was the restrained driver of a Tacoma towing a 23′ camping trailer. Pt tried to change lanes when the trailer started to wobble. Vehicle left the shoulder and flipped, landed on roof. Patient denies any loss of consciousness. States that she thinks at one time her arm may have been dragging out of the window at one point, states numbness in left arm.
• Off duty paramedic was on scene shortly after the crash, advises patients left shoulder looked like it was dislocated and may have self reduced. No hx of dislocation.


• Physical findings- Physical exam shows superficial cuts, scratches and bruise across left arm. Patient is tender to left shoulder palpation, tender to some range of motion, but tolerates most supported movement. Patient has strong left radial pulse, is able to move fingers, decreased sensation. All other systems normal. Denies head, neck or back pain. Denies SOB, CP.
• GCS- 15

Editor’s Notes

In this case, despite the patient having no neck pain, both the mechanism of injury and the potential for a “distracting injury” may suggest the need for placement of a cervical collar until definitive imaging can rule out cervical spine injury in the emergency department. Pls see supplemental material/video for further learning

– David Spiro, MD, MPH


• Gender: Female
• Age: 62 years
• Height: Not Available


• Temperature: Not Available
• Blood Pressure: 150/87
• Heart Rate: 92
• Respiratory Rate: 14
• Pulse Oximetry: 94% RA

Signs and Symptoms

7/10 L shoulder pain; clavicle pain

History Medical

• PMH: None per pt
• Allergies: NKA
• Dispatch info- MVC Roll over, 2 patients. Truck pulling a camper trailer, truck on its roof, driver and passenger are out of the vehicle.


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