Monday, March 16, 2009

The call comes over the radio and Ryan and I respond to a fall in the front lobby of the hockey arena. An elderly woman has taken her walker down the escalator and ended up falling down the last few steps. I take the call and carefully start assessing her, the poor woman has a slight mental impairment, a host of medical problems and is frightened and shaking like a leaf.

I check her shoulders and neck, running my fingers along her collarbone to assess stability. I check both her arms, running my hands down the bones to feel for deformities or swelling, watching her face for grimaces or any other indication of pain. All I find is a tender bruise starting to swell up just above her elbow; pulses, mobility, sensation, grip strength and everything else is normal. I check everything, running through the full assessment just to be sure. As I release her from my care, I tell her all I found was the bruise on her arm, but to go to the doctor and get checked out later if anything continues to hurt. Completely confident in my assessment and treatment, I fill out my paperwork and contently return to our seats in the stands to watch the end of the game.

Two weeks later, she approaches me at another game, her arm encased in a very supportive sling. "You know my arm that you said was just bruised?" She says with a slightly accusatory tone, "It turns out I broke my collarbone. I went to the doctor and it hurt more than all of my surgeries put together." Slightly dumbfounded, I stammer out an apologetic response while trying not to second-guess my basic assessment skills. As we part, I turn to Ryan in shame, "I thought I nailed that call, I checked everything! She had no pain, no swelling, no deformity, no instability, no nothing!" I barely hear his consolatory response as I'm lost in my own embarrassed thoughts.

I know I wouldn't have run that call differently if I came across it again, but I still feel bad that I missed it. I thought my skills were oh-so-good, I was getting cocky, especially in front of the newer members. I guess we all need to be knocked back to earth occasionally, even if its by something as simple as a broken collarbone.


Ryan said...

Hi Red, I am a long time reader, first time responder ;) That call was difficult based on the lack of information provided by the patient as well as her signs and symptoms presented. We can't catch them all Red, but we can learn from our experiences to be better suited for the next one. Keep up the great work!

Anonymous said...

Thats why you should tell every one of these patients to go to the hospital. The phrase should be "I don't have x-ray vision, so I can't tell for sure if anything is broken or not." Especially if the patient is a high-risk elderly person with (even if slight) altered mental status. Hospital, hospital, hospital.

Red said...

Thanks, Ryan. ;)

Anonymous - I usually use a line like that, that is good wording though, thanks!