Last week I accompanied a friend to a physician's visit. To make a long story short he slipped and fell on glare ice in the physician's driveway. There was a seven or eight second loss of consciousness, and within two hours he developed headache, nausea, and did not know what month it was. We trundled over to the nearest ER, where Nancy Nurse promptly advised him to wait in the waiting room. Wrong. Do not pass go. Do not collect two hundred dollars. Finally she said "you can loie down in my treatment room, but only until I need it." Hmmmmm. Well, I bypassed the electric gates and hot into the ER and found a physician who spoke English and, it being a saturday night they were understaffed with no MRI. They did have a CAT scan, which they engaged two hours later.
Diagnosis: Subdural hematoma. Bleeding out. One week later he is being released and is barely able to walk.
All this trouble from a simple fall.
Lessons learned: Be especially careful on ice. A contributing factor was he had some important papers under his arm. I witnessed the fall and believe had both arms been available to reach out, he might not have fallen or been able to break his fall. I slipped on the same patch opf ice a moment before him, had both arms available, and did not fall. I would recommend NOT TO CARRY ANYTHING when walking on icy surfaces. Another contributing factor was that he had been taking high dose aspirin per physician's instructions. This inhibited the ability of the blood to clot. I think it would have been wise had we kept a dose of vitamin K around for emergencies.
The other lesson is to INSIST upon prompt attention following ANY loss of consciousness from a physician if the triage nurse doesn't have the brains to hold a job in a bus terminal men's room.
The patient with the subdural hematoma is recovering nicely, improving day by day seven days after the event. An MRI scan shows the clot area has diminished in size and a craniotomy will not be necessary. The prompt treatment at an ER within the "window of opportunity" was a contributing factor. The hospital gave treatment to diminish swelling, as well as clotting factors. I do not mean to be too hard on the triage nurse, however she did not triage properly and did not recognize the seriousness of the event.
For example, in instances of neck flexure, particuliarly when there is loss of consciousness, cervical fracture must be ruled out. Axial traction and a neck brace/collar until x-ray/MRI is indicated. The nurse IMPROPERLY simply questioned the patient if he had sensation in the feet and movement. This is MEANINGLESS. You can have a cervical fracture that has not yet transected the cord. In addition they removed his coat by having him lift his arms (Arghhhh!). And this was a certified level II trauma center!
Alass...we rediscover the wheel every year.
It is very hard to give things a push in the right direction without being removed in handcuffs from the ER, unfortunately.
And of course they were going to MAIL the hospital records, and not release them with the patient.
Of course Nancy nurse said "we have rules".
Upwards in the chain of command, voice being raised.
A bit of guerilla theatre and we left with all the records.
The point of the tale is not to promote guerilla theatre, but in the event of a traumatic injury:
(1) Rule one. NEVER GET DISCHARGED WITHOUTH EVERY PAGE OF MEDICAL RECORD IN YOUR SWEATY HANDS!
Another friend of mine fell this week, and ended up with a subdural hematoma also. She is a wonderful 86 year old woman, and she doesn't own a cell phone. Too proud to use a cane or a walker. The weather outside had a wind-chill of 6 degrees F. She explained "I was just going to the store". As we know, there are times of the day when nobody at all walks outside. She lost consciousness, fell face foward and her guardian angel showed up in the form of two teenagers who immediately sent for an ambulance.
In this area the pay phones have all but disappeared, and the few remaining are vandalized.
We have excellent 911 coverage, but if they don't know you have a problem they cannot respond.
So todays recommendation is to get a cell phone and carry it with you. If you don't have enough money for two phones get the cell and lose the landline.
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