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Friday, 19 September 2014


 
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Case Study 14 February 2010
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Case Study 14 February 2010
Page 2

The Setting

There you are, hiking with a companion through the San Juan Mountains in Colorado, when suddenlyhorses 032.jpg there appeared a rider on a pale horse galloping across a meadow.  Your attempt to access a vague memory about pale horses passes into a focus on the beauty of the horse and rider which becomes a stumbling horse and airborne rider whose graceful flight ends in a tuck and roll as the horsewoman lands on her back, tumbles, stands and runs a few steps before finally collapsing in a heap.  

 

Your companion says “wow” as you fumble for your first aid kit and stumble toward the patient.  In the back of your mind you hear the voice of your WMI instructors saying quietly, “Slow down.  Scene size-up.”  This kicks in your WFR response.   Pausing to survey the scene, you observe that the horse is long gone.  You kneel next to the one patient, introduce yourself, and ask her permission to help.  She agrees, your friend holds her head, you don your gloves and begin the assessment. She seems alert and responding appropriately, although very anxious and in pain.  Her airway is clear and her breathing, while fast, appears adequate and unlabored.  Your blood sweep doesn’t find anything, her radial pulse is strong and fast.  The weather is warm and the ground dry, so you decide not to move her.  You roll back on your heels, take a deep breath and proceed with your assessment. 

 

SOAP Report

Subjective

The patient is a 21 yr old female whose chief complaint is pain on the right upper back and shoulder area. We witnessed the patient being thrown from a galloping horse, land on her back, tumble once, rise to her feet, run a few steps, then collapse.  We were at the patient’s side within a minute.

 

Objective

Patient Exam: Patient was found on her back. The head-to-toe exam revealed a 6” by 6” abrasion over her right scapula without point tenderness or active bleeding.  She has good CSM x4 and normal ROM in her right shoulder.  She does not think she lost responsiveness.  She was wearing a riding helmet.  She denies spine pain.  No other injuries are found.

 

 

Vital Signs
TIME

1530 hrs

1545 hrs

1630 hrs

LOR

A+Ox4

A+Ox4

A+Ox4

HR

120, regular, weak

100, regular, weak

88, regular, strong

RR

24, regular, shallow

22, regular, shallow

14,regular, easy

SCTM

Pale, cool, clammy

Pale, cool, clammy

Pale, warm, dry

BP

Radial pulses present

Radial pulses present

Radial pulses present

Pupils

PERRL

PERRL

PERRL

Not taken

Not taken

Not taken

 

 

 

History

Symptoms:

Patient is anxious and nauseated.  

Allergies:

Denies.

Medications:

Denies.

Pertinent Hx:

None.

Last in/out:

Patient reports normal urine and bowel movement today, ate lunch and drank 2 liters of water today plus some tea.

Events:

Denies any dizziness/other symptoms prior to fall from horse.

 

 What is your Assessment and Plan?  DO NOT click/peek at the next page without answering this first.



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