Moderator EMEDPA Posted March 14, 2014 Moderator Share Posted March 14, 2014 Recently saw an elderly gentleman with advanced alzheimers confined to bed with a knee injury as pictured in attachments(click to enlarge). Per the caregiver he "fell out of bed today". discuss Link to comment Share on other sites More sharing options...
skyblu Posted March 14, 2014 Share Posted March 14, 2014 Ouch! Does it extend intraarticularly? Osteopenic patient + low energy trauma could cause this. Are you concerned about elder abuse? Do you have the CT images? Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 14, 2014 Author Moderator Share Posted March 14, 2014 Ouch! Does it extend intraarticularly? Osteopenic patient + low energy trauma could cause this. Are you concerned about elder abuse? Do you have the CT images? View of the pelvis and proximal femur nl. Very concerned about elder abuse and reported as same. you got it in one. That's why I posted this. If the story don't fit, you must submit (with apologies to Johnny Cochran). No CT images. care transferred to ortho. Due to pts comorbidities and lack of weight bearing they are unlikely to repair this. I think it was just casted. The other issue with this is pain control. As you can imagine this must hurt like hell. I took this case as a sign out at the beginning of my shift. The guy had been in the dept > 1 hr and because he couldn't complain he didn't get any pain meds. I gave him some dilaudid. If nothing else at least it made me feel better and I'm assuming it helped the pt as well. Link to comment Share on other sites More sharing options...
Guest Paula Posted March 14, 2014 Share Posted March 14, 2014 Wow! I had the same response as skyblu. I sure hope the case is taken seriously for possible abuse. Link to comment Share on other sites More sharing options...
Guest JMPA Posted March 14, 2014 Share Posted March 14, 2014 although only limited to two angles, it appears to be a compression fracture. one would need to examine the foot and hip for a clearer picture. ecchymosis would be extremely helpful. certainly does not fit the moa of fall out of bed. underlying brittle bones are certainly a contributing factor, may not be abuse. it is common for caregivers to use that response for any unknown cause of injury Link to comment Share on other sites More sharing options...
skyblu Posted March 14, 2014 Share Posted March 14, 2014 I agree that a number of non-abuse mechanisms could cause such an injury even with low force in an osteopenic patient. However, our job is not to determine if there was abuse/neglect, but to report it if there is ANY suspicion. The investigation will be carried out by professionals trained in that field. I think EMED was right to find the story suspect. And holy moly, an hour with no pain control? We get dinged for that at our hospital. They track time to analgesia on all long bone fractures. Poor guy. This may well be a terminal event for him. Link to comment Share on other sites More sharing options...
Moderator EMEDPA Posted March 14, 2014 Author Moderator Share Posted March 14, 2014 I agree that a number of non-abuse mechanisms could cause such an injury even with low force in an osteopenic patient. However, our job is not to determine if there was abuse/neglect, but to report it if there is ANY suspicion. The investigation will be carried out by professionals trained in that field. I think EMED was right to find the story suspect. And holy moly, an hour with no pain control? We get dinged for that at our hospital. They track time to analgesia on all long bone fractures. Poor guy. This may well be a terminal event for him. that would probably be a blessing. kind of like when they call pneumonia " the old man's friend". Link to comment Share on other sites More sharing options...
Guest JMPA Posted March 14, 2014 Share Posted March 14, 2014 i would consider bone tomor on a differential. please elaborate on the course of the case. it would make an interesting article Link to comment Share on other sites More sharing options...
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