Mechanism of Injury

By Adem Lewis / in , , , /

Now let’s put the tools of discovery using
the mechanism of injury method to use. In this scenario, we’ve got a maybe a six year
old boy who was climbing on the bleacher system and it appears that they may have slipped
and fallen. So how do we apply mechanism of injury to this? Well, the first thing that
I’m going to do if he’s lying on the ground is, I’m going to look initially to see if
he’s okay. If he’s unconscious, unresponsive we may have a medical emergency of which I’m
not going to delay any further. I’m going to activate emergency medical services with
my cell phone or I’m going to tell somebody hey you in the plaid shirt, go call 911 and
call back, I might need your help as I continue my assessment. But in this case as we can
see, he’s sitting upright, he’s not crying. It looks like he might be holding his left
knee. Every now and again he kind of rubs it, so I’m already suspecting we may have
a left knee injury. But what kind of injury is it? Is it severe? Well, he’s got it bent.
It’s not angled or misformed, so it’s not something that’s jumping right out at me,
that it could be serious, but you never know. But as I look at the mechanism I know he climbed
off this step here. I can see muddy foot tracks on the seat itself and maybe he slipped and
as he slipped, did he hyper-extend his knee, causing a sprain or a strain or some kind
of dislocation injury. That’s my first one. Secondly, we have a rigid seat here. When
he slipped, did he hit the back of his head on the actual bleacher system as well. So
I might begin to ask him, “hey, does your head hurt? Do you have any pain anywhere?”
If this patient is able to talk to me, I’m going to use as many open-ended questions
as I can. I really don’t think it’s a good idea to ask specifics in every situation.
Because if I do, and I say “hey, does your shoulder hurt?” “Oh, yeah yeah, my shoulder
hurts.” “Does your stomach hurt?” “Oh, yeah, my stomach hurts too.” Sometimes we can lead
the patient down a path that doesn’t really exist. So I much more prefer to actually ask
them, “hey, can you tell me what hurts?” And let them point those things out to me. Now,
the whole time I’m going to be watching for unknowns. I already know that the mechanism
of injury not only could cause a sprain or a strain of the ankle, the knee, a back injury.
But I also know it could be a head injury. And if it is a suspected head injury we might
start seeing a loss of consciousness or a decreased level of consciousness. So I’m going
to be watching for that and obviously as soon as we have decreased level of consciousness,
airway, breathing or circulation problems, any kind of numbness, tingling, or inability
to move one of their forelimbs, it immediately becomes a 911 call and an emergency and they’re
going to be going in by ambulance. But right now we’re not sure if they have to go in by
ambulance. It might be that he just bumped his knee and it hurts and now I can kind of
incorporate the parent or the guardian or the nanny whose on the scene. And I can start
to ask them, “Is this little guy answering questions appropriately to you? Do they seem
like normal to you? Or do they seem maybe more lethargic or a little bit different?”
And kind of use them as a help. I can ask them “do they have any medical problems that
I should know about? Any allergies to medications?” and start putting kind of an assessment together.
I’m also going to make sure that I’m not completely myopic on this knee. I’m going to be thinking
of other potential injuries. Did he put an arm out when he fell and therefore sprain
a wrist or break a bone in his arm. And start kind of watching for those when I do my head
to toe exam looking for other not so noticeable injuries that I should also be aware of.

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