Mistake? Should I have backboarded?

[legion1202]

So last shift we ran from 630am to 530am the next day. One of my last calls I got was a 20 yr old male who got thrown to the ground in some snow by another male. The pt walked in his house up stairs and called 911 because he hurt his shoulder. We just got hit with a snow storm so he didn't feel like driving. Btw this was my first snow storm I have ever been in as well. I was teching the whole night haha

Anyways I find the pt sitting on his stairs holding his arm. I interview him and he tells me he got into a argument and this guy picked him up and pushed him back. His shoulder hurts and he thinks he re injured his rotator cuff. He denied neck and back pain and refused us carrying him with a stretcher at the time. I looked over his shoulder, back and neck and didn't find anything. His right shoulder hurt with palpating. He had no numbness in his arm or hand and had +cms. He could move his arm but with pain.pt also Denis loc or hitting his head. He walks to the rig fine and vs are perfect. He admits to drinking a few beers but is aaox3. Ride to the er is fine but as I'm bringing him into the er he starts saying he is having pain between his shoulder blades and it hurts for him to look down. I tell the nurse the pain in his back is a new on set and the pt agrees he only had shoulder pain during transport. I finish with the pt and on my next call he is still sitting there talking to the doc.. I hear the pt saying he now thinks something is wrong with his spine.

My question is should I have boarded c collared this guy? On the fact he got thrown to the ground or was I ok after ruling out neck and spine injury from the start? My gut says board them next time but with the snow and ice on the steps and walk way I thought that would be putting everyone in danger plus he wanted to walk. I guess I could have taken precaution in the truck...


I documented very well to save my *** but who knows if this guy will try to sue..the er nurse thought he was full of poop.. I dunno

 

[STXmedic]

I would've treated it the same way you did. Localized shoulder pain with no other complaints = no board and a nice, comfortable ride to the hospital.

 

[VFlutter]

I would not have boarded him

 

[MIT]

I don't think i would have backboarded or collared him- he didn't complain of neckpain or back pain, moves around without pain, mechanism of injury isn't that indicative, he's young and generally fit? and I assume that there was no pain on palpation? His onset of pain at triage sounds like muscular pain due to being seated and relatively motionless for whatever the transport time was

 

[mycrofft]

Did what I'd do. Especially documentation. If the boss calls you in just tell him like it was, say "Yes Ma'am" or "Sir", and press on.

You didn't, like, have any accidents on the drive in did you? Kidding.

PS: quick data to gather on something like this: document exactly where on shoulder there is pain (versus tenderness to palpation and ROM); have pt extend upper arm (lower arm usually comes along) anteriorly, posteriorly, and laterally, and document which directions if any elicit tenderness; you should be gently palpating shoulder as he does this, document any crepitus and in which direction it came. Not that it will affect your treatment necessarily (BTW did you sling and swathe it?), but changes in pain and tenderness are helpful at the other end as well as documentation you are uber thorough and couldn't possibly have just let anything slide. It also helps keep The Baron at bay.

 

[Medic Tim]

No board. A nice easy ride in the position of least discomfort. Some morphine if it is really hurting him.

 

[Handsome Robb]

No board. A nice easy ride in the position of least discomfort. Some morphine if it is really hurting him.

This, but fentanyl instead of MS

 

[Jon]

If you haven't had a patient start complaining of neck or back pain on ED arrival, you haven't been doing this long.

Usually he RN's understand when we say "that's new". Just document for CYA

 

[mycrofft]

I wasn't referring to "The Red Baron".

 

[legion1202]

Thanks everyone. Pt didn't want a sling .. His jacket was very bulky and he didn't want to remove it once in the truck due to the cold. He was comfortable sitting there so I didn't press it..

 

[mycrofft]

Hard to palpate and ROM in a ski suit, but it wasn't apparently emergent. How'd you getg BP throught a heavy coat? (Neck/Palp? ).

 

[Aidey]

1. No, he didn't need a LSB.

2. Epic, epic assessment fail. His jacket should have been removed. It is cold is a crappy excuse. Turn on the heat in the back. Give him a blanket. Have him take his arms out so the coat can be draped over his shoulders.

 

[Bullets]

If he didn't allow you to take off his coat, sling his arm, take vitals or do a physical assessment then I would have had a hard time taking him. If at any point prior to its leaving he said he called us just because he doesn't want to drive that probably would have ended as no medical merit and our service wasn't needed

 

[Veneficus]

125mg methylprednisone, 60mg ketorlac, problem solved...

 

[legion1202]

Whoa... He had no jacket when i checked him out in his house guys.. We put it on before leaving..

 

[legion1202]

Heat was on in the truck he didnt want to take his jacket iff again because it took us 10 mins to get it on.. Which caused pain to the pt i should have said that at the start

 

[abckidsmom]

Heat was on in the truck he didnt want to take his jacket iff again because it took us 10 mins to get it on.. Which caused pain to the pt i should have said that at the start

Why did you put it on?

 

[NYMedic828]

I never have a patient put their jacket fully on unless they are calling for nonsense and fully capable of putting in on and taking it off normally...

It always has to come off when we get to the ER and for our assessment so why put it on... Just put it on like a blanket or put it on backwards so it pulls right off.


I'm sure it was already stated, but any patient with debilitating pain, especially that which interferes with proper assessment should be administered analgesics.

 

[legion1202]

Pt wanted to walk to truck.. Refused stretcher.. Did not want ice pack or sling in his house. It was 14 degrees with freezing rain and wind.. The man wanted his coat.. He could move his arm.. But with 4/10 pain. I took v/s just fine and he was able to walk with no discomfort. His jacked was also helping stablizing his arm in a postion of comfort.. Like i said at the start i tried to do more in the truck but he refused.. He could drive to er becAuse he had a stick.. Transport time was 2-3 mins due to icey hills.. I guess i could have had hom refuse and have hin walk or go bu police car =)

 

[legion1202]

Oh and from his door to the truck was about 200yrd.. I was more worried about keeping pt warm then about having to take jacket off again.. I had no problem taking it off if i had too.. I the man had more layers of cloths on i would have put it on backwards but all he had was a t-shirt. Pt didn show that he was in a lot of pain untill he got to the er. My gut said he wanted to get checked out so he could report it and sue the guy who threw him.. I doubt there was anything wrong with him.. He was alao smoking a ciggette with that are when we arrived..

I agree i could have done something diffrent but its done now