Shelbmedic Posted November 14, 2006 Share Posted November 14, 2006 This call happened a few years back. I thought you might find it interesting. Unit 136 respond Code2 (non- emergency mode) for a 68 y/o M. post fall. Caller states husband got up slipped and fell approx. 2hrs ago. Denies any decreased LOC Post fall Assessment code 2 will be fine. Dispatch out! Just as you are pulling into the drive way Dispatch calls back for ETA and an up date and to advise you that the Pt know has a Decreased LOC. Arrived on scene @ 05:00 hrs scene is safe, Your met at the door by his wife and a family friend. They both state that Joe got up at 03:00 hrs when he tripped over his feet falling to the hard wood floor striking the right side of his head on the base board in the hall. As you and your partner are walking to the master bedroom you noticed a large blood stain on the side of the wall next to where the pt had fallen earlier. You ask his wife was he knocked out she states no but he is C/O of a H/A then she says he has been up to the bathroom several times to Vomit. Just before you guys got here Joe tried to get out of bed but he couldn't and he threw up all over himsef and had a massive BM that the wife had tried to clean up before you go there. You ask for Joe's medical history wife and friend both stae that Joe has DIC (Disseminated Intravascular Coagulation Dissorder And has weekly Blood transfusions at the local Hospital. and he is is not allowed to take ASA. You walk in to the master Bedroom you findyour pt. lying supine in bed covered in vomit and is haveing a seizure. You also notice the pressure bandage that is Blood soaked on the right side of his head. Pt stops the seizure. You Find 68 male Not alert . A- Pt has gag reflex post seizure when you try opa B - 12 times shallow C- 180/90 p[ulse 120 strong Chemstrip 8.0mmol Spo2 94 R/A S/S of trauma is the Rt side of his head 1-2" Lac with Pressure bandage on it Lungs clear egula bilat Abd soft NT/ND pelvis stable / no other s/s of trauma noted 12 lead showed Sinu Tach Pupils ER left was sluggish PMH DIC / Blood transfussion weekly / is not allowed to have ASA one last bit of information as we were back boarding this pt he comes too and is CAOx4 does not want to go to hospital what do you do??? Link to comment Share on other sites More sharing options...
becksdad Posted November 14, 2006 Share Posted November 14, 2006 I convince patient and family to accept Tx and transport, using the strongest terms necessary. Patient has S/S of head injury. Nausea/vomiting-seizure-pupillary changes. Delayed symptoms post fall to me are more ominous than immediate & transitory changes. I believe it is also common for those with severe head injury to have a lucid period before truly crashing from ICP. Patient is already hypertensive - I would expect that to increase as well as widening of pulse pressure even further. I would also expect patient to become bradycardic and develop an irregular respiratory pattern. Sounds to me like this guy likely has a very serious head injury. Link to comment Share on other sites More sharing options...
Ridryder 911 Posted November 14, 2006 Share Posted November 14, 2006 If he is conscious alert and well orientated, advise him and his wife of potential risks (including death), an dangers, notify medical control and see if they could convince him of transport. If not then there is nothing more you can do. It is his right (patent's rights) to refuse any treatment and transport. R/r911 Link to comment Share on other sites More sharing options...
medic001918 Posted November 14, 2006 Share Posted November 14, 2006 If he is conscious alert and well orientated, advise him and his wife of potential risks (including death), an dangers, notify medical control and see if they could convince him of transport. If not then there is nothing more you can do. It is his right (patent's rights) to refuse any treatment and transport. R/r911 I have to agree with Rid here. The patient certainly has the right to refuse care as long as he is aware and able to understand the consequences of those actions, including death. This is a call that I would like to see medical control assist in trying to convince the patient to go to the hospital, and one that would need every attention paid to details in the refusal (not that we don't already do that anyway, right?). I'm agreeing with becksdad as well, that these delayed s/sx are highly indicative of a head injury and are concerning. I'm going with subdural hemmorage for this patient since the signs and symptoms are delayed. Shane NREMT-P Link to comment Share on other sites More sharing options...
Shelbmedic Posted November 14, 2006 Author Share Posted November 14, 2006 We advised the pt. that he had been unresponsive and that we thought that he might have a head injury especially with his PMH of DIC and that if not treated at the trauma center there could be a fatal out come of death. Pt stated I don't care I'm not going and Family and friends were of no help so I called ONLMC and he agreed it sounds like a subdural bleed and wants the pt taken to hospital. while the pt was being explained that he should go and the on line Dr. said for him to go pt had a big time decreased of LOC became very combative and vomiting big time I was still on line when this was going on and requested life flight to meet us at the local hospital to transport to the trauma center 2hrs away by ground. Pt vitals Pupil lt wide no reactive B/P 220/120 H/R130 load and go and did the following pt still had gag reflex was given and resp 10 GCS 5 . c-spined ,IV 14 Rt AC TKV at present. Pt then given 1.5 mg/kg lido cain IVP as per protocol and then Lido sprayed the cords pt intubated #8.5 22at lips pt started posturing as life flight was putting him in the bird. He died 2hrs later in ICU Link to comment Share on other sites More sharing options...
Thunderchild145 Posted November 15, 2006 Share Posted November 15, 2006 Wow. Bad luck. Something got to his brain stem. Can't usually live through that for long. Link to comment Share on other sites More sharing options...
Ridryder 911 Posted November 15, 2006 Share Posted November 15, 2006 No matter how much we try to save their life either they will refuse or going on an end up dying on us!... We can never win! R/r Link to comment Share on other sites More sharing options...
whit72 Posted November 15, 2006 Share Posted November 15, 2006 I am wondering with his hx of DIC, why his wife didn't immediately call 911 after the fall? Link to comment Share on other sites More sharing options...
MedicRN Posted November 15, 2006 Share Posted November 15, 2006 Wow. Bad luck. Something got to his brain stem. Can't usually live through that for long. Based on the hx of DIC, I would venture to guess he had a rapidly expanding subdural bleed (and maybe a few other bleeds) and herniated through the Foramen Magnum. The last VS he gave was showing increased intracranial pressure and a probable herniation in progress. Sounds like Shelbmedic did his best to get him the care he needed. Link to comment Share on other sites More sharing options...
ERDoc Posted November 15, 2006 Share Posted November 15, 2006 I think with someone like this, you need to be a little more forceful. When the risks are explained, I would not say, "you could die," I would try something more along the lines of, "you will die." Also make sure the family hear this. I'm going to guess that this wasn't a very educated family and they did not understand the full consequences of his underlying problem. Sometimes you can educate till your face turns blue, but you are only ](*,) Link to comment Share on other sites More sharing options...
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