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usmc_chris

Dizziness with Fall

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Hello,

I haven't posted in a while, but I have an interesting case to run through the scenarios forums. So here goes.

You work for a busy urban service. You are working on a Medic/EMT truck. At approximately 12:30pm you are dispatched with the fire department BLS first response for a report of a 40 y/o male c/o dizziness who has fallen at church. While enroute the call is re-coded as a syncope/unconscious instead of a fall, but no further information is provided by dispatch.

Your scenario begins as you arrive on scene, you arrive within approximately 6 minutes of the initial dispatch. The weather is fair and sunny, around 60 degrees Fahrenheit. You see a crowd, including your fire department first responders, gathered around an approximately 40 y/o black male who is lying supine on the sidewalk outside of church.

Your two closest facilities are a Level I trauma center, with the full range of services, and a Level III trauma center which has PCI capabilities and off-site neurosurgical capabilities at a sister hospital about 5-6 miles further down the road. Both facilities are an approximately 10-15 minute transport from your current location, depending on traffic conditions.

What would you like to know / do?

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Lets talk ABC's. Does he have a pulse? Or am I working a trauma code?

How far did he fall? What was he doing before he fell?

Anyone of the bystanders know his past medical hx?

I would also start with a rapid trauma assessment:

COG: is he COA now or still unconsious/unresponsive?

Head: What do I see? PERLA? Normocephalic? Blood and CSF leaking from ears?

Neck: JVD? Trachea midline? Back of the neck have injuries? What are they? Bruising/swelling?

Chest: Symetrical? Breathing normally or do I have paradoxical movement? Lung sounds equal in all fields?

Abd: soft, non-tender or distended and painful?

Pel: any bruising, swelling or crepitous noted? Priaprism?

EXt: any obvious injuries to extremities x 4?

Back: injuries? Bruising/swelling/crepitous?

SMR will be initiated. IV, O2 and rapid transport.

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Lets talk ABC's. Does he have a pulse? Or am I working a trauma code?

How far did he fall? What was he doing before he fell?

Anyone of the bystanders know his past medical hx?

I would also start with a rapid trauma assessment:

COG: is he COA now or still unconsious/unresponsive?

Head: What do I see? PERLA? Normocephalic? Blood and CSF leaking from ears?

Neck: JVD? Trachea midline? Back of the neck have injuries? What are they? Bruising/swelling?

Chest: Symetrical? Breathing normally or do I have paradoxical movement? Lung sounds equal in all fields?

Abd: soft, non-tender or distended and painful?

Pel: any bruising, swelling or crepitous noted? Priaprism?

EXt: any obvious injuries to extremities x 4?

Back: injuries? Bruising/swelling/crepitous?

SMR will be initiated. IV, O2 and rapid transport.

Hold on there turbo. Let's assess whether or not SMR is indicated before we decide to do it. I agree with doing a quick trauma assessment but the trauma aspect may well be secondary to this patients primary issue.

ABCs, LOC, trauma assessment, vitals (including BGL and initial rhythm), history (event and patient)... Then decide what direction we should take this.

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ok for the abbreviation challenged, what is SMR?

Here is the problem with using abbreviations that I have. I did a google search because well dammit I'm not familiar with the SMR acronym and these are just one list of SMR Abbreviations I came up with. I dont' really think that Strategy Mangement and Research is the answer nor Severe Mental Retardation is the answer.

So let's stop using abbreviations please.

Standardized Mortality Ratio
severe mental retardation
sexual maturity rating
Skeletal muscle relaxant
S
tandard mortality rate
standard mortality ratio
submucous resection
scanning microradiography
scatter maximum ratio
schistosomal myeloradiculopathy
Scottish Morbidity Record
senior medical resident
Sensorimotor rhythm
sexual maturity ratings
sleeping metabolic rate
small multidrug resistance
somnolent metabolic rate
standard metabolic rate
standard metabolic rates
Standard Morbidity Ratio
standard mortality rates
standardised mortality rate
Standardised Mortality Ratio
standardised mortality ratios
standardized morbidity rates
standardized morbidity ratio
standardized morbidity ratios
standardized mortality rates
stepwise multiple regression
streptomycin resistance
streptomycin-resistant
stroke with minimum residuum
sulfamerazine

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Agree on the abreviations. There are so many that I see on here where I just scratch my head and hope I can figure it out based on context. WTF are DCAPSBTLS or PMS (not the female kind)? As for the original scenario, I think we are putting the carriage before the horse. Why did he fall? Was he walking and passed out? Did he fall off a ladder? Did he fall out of an unidentified Boeing 777?

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Agree on the abreviations. There are so many that I see on here where I just scratch my head and hope I can figure it out based on context. WTF are DCAPSBTLS or PMS (not the female kind)? As for the original scenario, I think we are putting the carriage before the horse. Why did he fall? Was he walking and passed out? Did he fall off a ladder? Did he fall out of an unidentified Boeing 777?

well doc if he fell out of the unidentified 777 then he is triple screwed.

But seriously, we need more info before we start down any road of SMR, I mean SMR is normally reserved for the Stepwise multiple regression of the Superficially Medically Refined in a Super Macho Resistence. I mean SMR AMR PMR EMR IMR vmr and that's my story and I'm smr'ng to it.

ok, it's late and I'm tired.

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Agree on the abreviations. There are so many that I see on here where I just scratch my head and hope I can figure it out based on context. WTF are DCAPSBTLS or PMS (not the female kind)? As for the original scenario, I think we are putting the carriage before the horse. Why did he fall? Was he walking and passed out? Did he fall off a ladder? Did he fall out of an unidentified Boeing 777?

DCAPBTLS

Deformities

Contusions

Abrasions

Punctures/penetrations

Burns

Tenderness

Lacerations

Swelling

PMS=

Pulse

Motor

Sensation/sensory

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well doc if he fell out of the unidentified 777 then he is triple screwed.

But seriously, we need more info before we start down any road of SMR, I mean SMR is normally reserved for the Stepwise multiple regression of the Superficially Medically Refined in a Super Macho Resistence. I mean SMR AMR PMR EMR IMR vmr and that's my story and I'm smr'ng to it.

ok, it's late and I'm tired.

Point made. Now let's stop derailing the original poster's thread and allow the case to run its course.

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Point made. Now let's stop derailing the original poster's thread and allow the case to run its course.

But no-one has said what SMR means. Unless I missed it.

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