Emergency Dept Case StudiesEmergency Dept Case StudiesHip FxHip Fx

Mr. F is an 82 yo male from the Coolidge House who presents to the Emergency Department s/p fall. Staff of the nursing home notified the EMT’s that the patient has not been able to ambulate since the fall 2 hours ago. The EMT noted the left leg to be shortened and externally rotated. Patient is alert and oriented x3.

What other information do you need concerning the fall?

How did the patient fall- trip and fall or other precipitating factors such as chest pain, dizziness? Patient may need work-up for MI or syncope.

The patient has full recall of events and states that he tripped over the rug. Mr. F states he did hit his head but did not lose consciousness. His VS are 190/100, 92, 28. What important information would you need at this time? Why is early measurement of VS particularly important in patients with known or suspected injuries of the pelvis?

Is the patient on coumadin or other anticoagulation medication? Is a head CT necessary in this case? (unless patient had LOC or is on anticoagulants head CT probably not necessary).

Early VS in these patients is necessary because they could have a bleed into the pelvis and become hypotensive.

After obtaining the above information, what interventions or diagnostic procedures should be initiated?

 

Full medical workup can be initiated if highly suspect hip fracture. This includes EKG, #18 angio, and pre-op labs (including- cbc, sma-7, pt/ptt, type and screen). Place a foley- send ua to lab.

Foley is necessary for a couple of reasons:

           May be too painful for patient to get on/off bedpan

           Determine if any damage to the GU tract or obstruction from swelling.

Also may order hip/pelvic films

Anticipate chest x-ray- if + hip fracture pt will need pre-op chest film