Paramedic Colleague Case

Case 2
Myself and my paramedic colleague were dispatched to an incident with the details given as; 72 year old female, fallen, landed onto hard floor, lower back pain, unable to move. On route to this incident I started to think about the elements I would have to consider on our arrival. I immediately started to think about possible immobilisation of our patient, what possible injuries she could have from falling? Why has she fallen? Was it a medical episode that caused her to fall? I believe this was hard to start forming a provisional diagnosis until I knew the full history including mechanisms of injury. On arrival at the address the patient was laying on the lounge floor, Glasgow coma scale (GCS)15, alert and responsive, normal effort of
I inspected for any deformities, abnormalities whilst observing the patient’s behaviour. As part of my working diagnoses I was suspecting head injury along with cervical spine injury due to falling, as this was trauma related to back pain, I considered possible fractures or dislocations, soft tissue injury, also as the patient has a history of lower back pain and surgery. If there was not history of a trip I would be suspecting a possible medical cause, vascular, urinary, nervous or gastrointestinal systems possibly being to blame.
Our patient complained of lower back pain, Bates (2013) suggests that 40% of adults have low back pain and is one of the most common reasons of visits to the doctors. She also stated she had numbness in her saddle region, there was no evidence of head injury or Cervical spine pain at that stage. I then applied a mnemonic “O.L.D.C.A.R.T.S” to focus my assessment on her back pain. Bates (2013) explains that this mnemonic covers the onset, location, duration, characteristics, aggravating/alleviating factors, radiation, timing and
On inspection of the cervical spine there was no pain or tenderness, each spinal process was palpated also checking for swelling. Once I was clear there was no pain or tenderness present I asked the patient to move her neck to assess movement, Mcaleod (2014) informs that asking the patient to chin to chest, look upwards as far as possible is a great way of assessing flexion and extension. I then proceeded to the thoracic spine, palpating the spinal processes and lastly the lumbar area of the spine. The patient did complain of pain over the Lumbar area of L4 and L5, but she would normally have pain within this area, but felt it worsened by the fall this evening. My initial thoughts were exacerbation of ongoing chronic lower back pain made worse by the fall, but due to the pervious back surgery and new saddle numbness, I feel I was justified in immobilising our patient at this stage. My working diagnoses was now a possible fracture, back strain, herniated disc or even cauda equine (CES), Cauda equine syndrome was first reported in 1934 by Mixter and Barr. It occurs when the nerves in the corda equine area are compressed. CES is most commonly presented with a lumbar disc herniation Lavy et al,