Saturday, September 7, 2013

Falling with Grace or Without?

The tones sound for a man who has fallen from a two story roof. As the ambulance maneuvers through traffic the other drivers seem to intuitively understand this is a true emergency and they move to the right for the ambulance. Unfortunately, this is not always the case and just getting the ambulance and paramedics to the scene is a dangerous venture.

During the response, the 911 dispatcher relays the information they are receiving from the caller, it sounds like the patient is unconscious and bleeding from his head. As we arrive we find a man laying near the sidewalk next to his house. There are family members tending to him and they have a look of fear in their eyes. The scene is chaotic with blood on the sidewalk and the victim still unconscious as neighbors look on and ask if they can do anything to help. My partner moves into place at the patient's head and manually stabilizes the patient's cervical spine, I ask if anyone saw the accident. A young man comes forward and explains the victim is his dad and he saw him fall from the upper roof and landed on the garage roof. He landed hard and then rolled off of the garage roof and landed on his head on the sidewalk. The boy was crying and asks if his father is going to die. I hate these questions. I understand why they ask but the only response we can give is "we will do everything we can to help him" and then try to extend some kind of hope to the loved one with the most positive aspect of the patient's condition. Sometimes the only good thing to say is "he has a pulse" or "he is talking to me". If I say "he's going to be ok" or "don't worry he's not hurt badly" and the patient dies or suffers with chronic long term injuries I could have a lawyer knocking on my door asking what I did to change the patient's out come.

This patient is carefully rolled onto a back board with a cervical collar in place and loaded into the ambulance. While en route to the hospital a physical exam reveals the patient has a suspected skull fracture and fracture of the left collar bone (clavicle). Two IVs are started and fluid resuscitation is imitated as oxygen is given by mask. The patient begins to move and starts responding to questions about the event. He is confused but answers most questions appropriately. 

Later we find out the patient has a skull fracture, a fractured shoulder blade (scapula) and his clavicle is fractured. He also has an epidural hematoma

                 An Epidural hematoma is a type of traumatic brain injury (TBI)  where a buildup of blood occurs between the dura mater (the tough outer membrane of the central nervous system) and the skull. The condition is potentially deadly because the buildup of blood may increase pressure in the intracranial space causing delicate brain tissue to be compressed and the brain to shift. Between 15 and 20% of epidural hematomas are fatal.

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