The Nation's Health + trauma

Out of Place

"93 year old female, fall"

It's that time of the shift again, 'Nan down'! I've said previously that these are generally my favourite types of job. The patients are normally polite and extremely grateful for us being there. Sometimes we get tea and biscuits and more often than not, they don't go to hospital. It is also nice to go to someone who genuinely needs us.

We pulled up outside and were beckoned towards the house by the concerned neighbour who had found her on the floor.

"She's been there for 12 hours, bless her. She's in the downstairs toilet."

Poor thing. I headed round the hallway to where she was and what I saw shocked even me. I just starred for a few seconds and made the following observations.

  1. That shouldn't be facing that way!
  2. That shouldn't be up there!
  3. That shouldn't be that colour!
  4. How in God's name are we going to get her out?!?
So, with or without medical knowledge we all have a grasp of human anatomy. We all know, therefore, that the foot has no place anywhere near the shoulder. We also know that it shouldn't be blue. THAT is what was facing us! Not only was her leg so badly twisted / fractured / dislocated, but her other leg was wrapped round the toilet and her arm was stuck behind some pipes. It was like a contortionist meets a Rubiks cube + injuries.

We immediately asked for more hands. No way would 2 of us be able to get her out of there. She apologised for wasting our time! If only she could have met our last patient who was drunk in the street and full of venom. (In fact the way he was spitting resembled a venomous snake!) I started her on Entonox while we tried to assemble some kind of plan. Unfortunately, like most other bizarre jobs, this ISN'T in the books! A couple of FRUs arrived and joined in the "ooohh's" and "eeeek's" and "ouch's". We decided it was going to be best to free the limbs that would be 'easily' freed, get some IV access, load her up with morphine, get her out with the bad leg still in that ghastly position, and then finally straighten her leg. Simple!

Bear in mind it was a tiny downstairs toilet, and there was a step down into it, we managed to get two of us inside and one in the doorway. We set about freeing her arm first which just involved forcing the pipes away from the wall long enough for the arm to be retrieved. I had visions of the pipe bursting and us all being in a whole world of difficulty! Luckily the arm came out without drama. With some light force and assistance her good leg shortly followed. Luckily for a 90+ year old she had relatively good veins so cannulating her turned out to be rather simple! Within a few minutes, the morphine was in and she was complaining of less pain. Now the 'fun' bit!

The doorway wasn't wide enough for us to be able to lift her in the position she was in and carry her out. The room wasn't wide enough to realistically straighten her leg inside and then get her out so some more head scratching occurred! It was decided that a rescue board would be slid down to us. We'd lift her off the floor a few inches whilst the board was slid underneath. Then, we'd carefully slide her along the length of the board, through the doorway and into the hallway. It worked a charm! Now for the leg. After another dose of morphine and plenty of Entonox we went for it, slowly. I felt a vile click as her knee cap moved about but now her leg was straight (ish). By 'straight' I'm not taking into account that her foot was still facing the wrong way. The fracture dislocation of the ankle was going to be left for the hospital to deal with. We secured it into a vacuum splint, continued with pain relief and got her out and off to hospital as quickly as possible.

The position she had been in was so bizarre, it was hard to explain to the waiting trauma team just exactly how we found her and what state her leg was in when we got there. Even the Orthopod, who enjoys breaking bones on a daily basis, pulled a grimacing face. He said it was the worst case of 'shoulder foot' he'd heard of!

Very rarely do I see injuries that make my stomach turn and it isn't often that I look at someone and literally don't know where to start! People manage to fall and get stuck in some of the most incredible positions! I really don't know how. I just hope I'm never unfortunate enough to do anything similar. I can't even comprehend the pain. It doesn't bear thinking about!

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Relevant to: Out of Place + trauma