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Will/Grundy EMS Continuing Education January 2011 Written by: -Laurie Carroll, RN, Advocate Bolingbrook Hospital -Will/Grundy EMS Staff.

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Presentation on theme: "Will/Grundy EMS Continuing Education January 2011 Written by: -Laurie Carroll, RN, Advocate Bolingbrook Hospital -Will/Grundy EMS Staff."— Presentation transcript:

1 Will/Grundy EMS Continuing Education January 2011 Written by: -Laurie Carroll, RN, Advocate Bolingbrook Hospital -Will/Grundy EMS Staff

2 Differential Diagnosis of Chest Pain There are literally dozens of illnesses, injuries and conditions that can cause chest pain. Knowing common signs, symptoms and patient presentations can help you differentiate between different kinds of chest pain. Bottom Line: If you are ever not sure what kind of chest pain you are dealing with, treat it as cardiac and call medical control.

3 Differential Diagnosis of Chest Pain Common Causes of Chest Pain Cardiovascular: ischemia (AMI or angina) pericarditis (irritation of pericardium) thoracic aortic dissection

4 Differential Diagnosis of Chest Pain Common Causes of Chest Pain Respiratory: PE (pulmonary embolism) pneumothorax pneumonia pleural irritation hyperventilation (anxiety)

5 Differential Diagnosis of Chest Pain Common Causes of Chest Pain Gastrointestinal: cholecystitis (gall bladder/gallstones) pancreatitis hiatal hernia (part of stomach pushes through diaphragm) esophageal disease/GERD peptic ulcers dyspepsia (indigestion)

6 Differential Diagnosis of Chest Pain Common Causes of Chest Pain Musculoskeletal: chest wall syndrome (inflamed chest wall) costochondritis (inflamed rib cartilage) herpes zoster (shingles) chest wall trauma chest wall tumors

7 CAUSE ONSET OF PAIN CHARACTERISTIC OF PAIN LOCATION OF PAIN HISTORY ASSOCIATED SX/SX AGGRAVATING FACTORS RELIEVING FACTORS QUESTIONS TO HELP DIFFERENTIATE CHEST PAIN

8 DETERMINE ONSET/DURATION OF PAIN Was it… Sudden? Gradual? Lasts Minutes? Lasts Hours? Varies?

9 “QUALITY” OF PAIN PLEURITIC (sharp pain with inhalation) SPASMODIC (like a spasm) TIGHTNESS OR HEAVINESS PRESSURE- OPPRESSIVE SHARP/LOCALIZED (easy to pinpoint) VISCERAL (hard to pinpoint)/BURNING TEARING / EXCRUCIATING

10 LOCATION SUBSTERNAL CENTER OR ACROSS CHEST LATERAL CHEST LOCALIZED OVER INVOLVED AREA LOWER CHEST/EPIGASTRIC RADIATES TO JAW, NECK, BACK OR ARM VAGUE

11 HISTORY AGE PREVIOUS EPISODES UPPER RESPIRATORY INFECTION/FEVER TRAUMA STRESS EMOTIONAL UPSET CARDIAC DISEASE – HTN, CAD, ANGINA PHLEBITIS

12 Associated Signs/Symptoms? DYSPNEA DIAPHORESIS NAUSEA / VOMITING AMS /WEAKNESS /LIGHTHEADEDNESS / SYNCOPE NEURO CHANGES HYPO OR HYPERTENSION OR UNEQUAL BP DECREASED OR ABNORNMAL BREATH SOUNDS CYANOSIS HEMOPTYSIS (coughing up blood) PULSATING ABD MASS ABDOMINAL PAIN VESICULAR PAIN WITH PALPATION RASH OR LESIONS

13 AGGRAVATING FACTORS? BREATHING MOVEMENT STRESS EXERTION AFTER EATING OR ETOH LAYING DOWN SITUATIONAL / ANXIETY

14 RELIEVING FACTORS – What makes it feel better? REST OR DECREASED MOVEMENT POSITION SITTING UP OR LEANING FORWARD DECREASED OR SHALLOW BREATHING DIET ANTACIDS MEDICATIONS

15 Now lets match the chest pain diagnosis with the symptoms…. The list items in red italics are the ones that go with the diagnosis….

16 ANGINA ONSET/DURATION OF PAIN Sudden Gradual Lasts Minutes Lasts Hours Varies

17 ANGINA QUALITY PLEURITIC SPASMODIC TIGHTNESS OR HEAVINESS PRESSURE- OPPRESSIVE SHARP/LOCALIZED VISCERAL/BURNING TEARING / EXCRUCIATING

18 ANGINA LOCATION SUBSTERNAL CENTER OR ACROSS CHEST LATERAL CHEST LOCALIZED OVER INVOLVED AREA LOWER CHEST/EPIGASTRIC RADIATES TO JAW, NECK, BACK OR ARM VAGUE

19 ANGINA HISTORY AGE PREVIOUS EPISODES UPPER RESPIRATORY INFECTION/FEVER TRAUMA STRESS EMOTIONAL UPSET CARDIAC DISEASE – HTN, CAD, ANGINA PHLEBITIS

20 ANGINA ASSOCIATED SX / SX DYSPNEA DIAPHORESIS NAUSEA / VOMITING AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE NEURO CHANGES HYPO OR HYPERTENSION OR UNEQUAL BP DECREASED OR ABNORNMAL BREATH SOUNDS CYANOSIS HEMOPTYSIS PULSATING ABD MASS ABDOMINAL PAIN VESICULAR PAIN WITH PALPATION RASH OR LESIONS

21 ANGINA AGGRAVATING FACTORS BREATHING MOVEMENT STRESS EXERTION AFTER EATING OR ETOH LAYING DOWN SITUATIONAL / ANXIETY

22 ANGINA RELIEVING FACTORS REST OR DECREASED MOVEMENT POSITION SITTING UP OR LEANING FORWARD DECREASED OR SHALLOW BREATHING DIET ANTACIDS MEDICATIONS

23 Acute Myocardial Infarction ONSET/DURATION OF PAIN Sudden Gradual Lasts Minutes Lasts Hours Varies

24 Acute Myocardial Infarction QUALITY PLEURITIC SPASMODIC TIGHTNESS OR HEAVINESS PRESSURE- OPPRESSIVE SHARP/LOCALIZED VISCERAL/BURNING TEARING / EXCRUCIATING

25 Acute Myocardial Infarction LOCATION SUBSTERNAL CENTER OR ACROSS CHEST LATERAL CHEST LOCALIZED OVER INVOLVED AREA LOWER CHEST/EPIGASTRIC RADIATES TO JAW, NECK, BACK OR ARM VAGUE

26 Acute Myocardial Infarction HISTORY AGE PREVIOUS EPISODES UPPER RESPIRATORY INFECTION/FEVER TRAUMA STRESS EMOTIONAL UPSET CARDIAC DISEASE – HTN, CAD, ANGINA PHLEBITIS

27 Acute Myocardial Infarction ASSOCIATED SX / SX DYSPNEA DIAPHORESIS NAUSEA / VOMITING AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE NEURO CHANGES HYPO OR HYPERTENSION OR UNEQUAL BP DECREASED OR ABNORNMAL BREATH SOUNDS CYANOSIS HEMOPTYSIS PULSATING ABD MASS ABDOMINAL PAIN VESICULAR PAIN WITH PALPATION RASH OR LESIONS

28 Acute Myocardial Infarction AGGRAVATING FACTORS BREATHING MOVEMENT STRESS EXERTION AFTER EATING OR ETOH LAYING DOWN SITUATIONAL / ANXIETY

29 Acute Myocardial Infarction RELIEVING FACTORS REST OR DECREASED MOVEMENT POSITION SITTING UP OR LEANING FORWARD DECREASED OR SHALLOW BREATHING DIET ANTACIDS MEDICATIONS

30 Dissecting Aneurysm ONSET/DURATION OF PAIN Sudden Gradual Lasts Minutes Lasts Hours Varies

31 Dissecting Aneurysm QUALITY PLEURITIC SPASMODIC TIGHTNESS OR HEAVINESS PRESSURE- OPPRESSIVE SHARP/LOCALIZED VISCERAL/BURNING TEARING / EXCRUCIATING

32 Dissecting Aneurysm LOCATION SUBSTERNAL CENTER OR ACROSS CHEST LATERAL CHEST LOCALIZED OVER INVOLVED AREA LOWER CHEST/EPIGASTRIC RADIATES TO JAW, NECK, BACK OR ARM VAGUE ABDOMEN

33 Dissecting Aneurysm HISTORY AGE PREVIOUS EPISODES UPPER RESPIRATORY INFECTION/FEVER TRAUMA STRESS EMOTIONAL UPSET CARDIAC DISEASE – HTN, CAD, ANGINA PHLEBITIS

34 Dissecting Aneurysm ASSOCIATED SX / SX DYSPNEA DIAPHORESIS NAUSEA / VOMITING AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE NEURO CHANGES HYPO OR HYPERTENSION OR UNEQUAL BP DECREASED OR ABNORNMAL BREATH SOUNDS CYANOSIS HEMOPTYSIS PULSATING ABD MASS ABDOMINAL PAIN VESICULAR PAIN WITH PALPATION RASH OR LESIONS

35 Dissecting Aneurysm AGGRAVATING FACTORS BREATHING MOVEMENT STRESS EXERTION AFTER EATING OR ETOH LAYING DOWN SITUATIONAL / ANXIETY In other words, it hurts badly no matter what.

36 Dissecting Aneurysm RELIEVING FACTORS REST OR DECREASED MOVEMENT POSITION SITTING UP OR LEANING FORWARD DECREASED OR SHALLOW BREATHING DIET ANTACIDS MEDICATIONS In other words, nothing helps it feel better.

37 PERICARDITIS ONSET/DURATION OF PAIN Sudden Gradual Lasts Minutes Lasts Hours Varies

38 PERICARDITIS QUALITY PLEURITIC SPASMODIC TIGHTNESS OR HEAVINESS PRESSURE- OPPRESSIVE SHARP/LOCALIZED VISCERAL/BURNING TEARING / EXCRUCIATING

39 PERICARDITIS LOCATION SUBSTERNAL CENTER OR ACROSS CHEST/RETROSTERNAL LATERAL CHEST LOCALIZED OVER INVOLVED AREA LOWER CHEST/EPIGASTRIC RADIATES TO JAW, NECK, BACK OR ARM VAGUE

40 PERICARDITIS HISTORY AGE PREVIOUS EPISODES UPPER RESPIRATORY INFECTION/FEVER TRAUMA STRESS EMOTIONAL UPSET CARDIAC DISEASE – HTN, CAD, ANGINA PHLEBITIS

41 PERICARDITIS ASSOCIATED SX / SX DYSPNEA DIAPHORESIS NAUSEA / VOMITING AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE NEURO CHANGES HYPO OR HYPERTENSION OR UNEQUAL BP DECREASED OR ABNORNMAL BREATH SOUNDS CYANOSIS HEMOPTYSIS PULSATING ABD MASS ABDOMINAL PAIN VESICULAR PAIN WITH PALPATION RASH OR LESIONS PARADOXICAL PULSE

42 PERICARDITIS AGGRAVATING FACTORS BREATHING MOVEMENT STRESS EXERTION AFTER EATING OR ETOH LAYING DOWN SITUATIONAL / ANXIETY

43 PERICARDITIS RELIEVING FACTORS REST OR DECREASED MOVEMENT POSITION SITTING UP OR LEANING FORWARD DECREASED OR SHALLOW BREATHING DIET ANTACIDS MEDICATIONS

44 PNEUMOTHORAX ONSET/DURATION OF PAIN Sudden Gradual Lasts Minutes Lasts Hours Varies

45 PNEUMOTHORAX QUALITY PLEURITIC SPASMODIC TIGHTNESS OR HEAVINESS PRESSURE- OPPRESSIVE SHARP/LOCALIZED VISCERAL/BURNING TEARING / EXCRUCIATING

46 PNEUMOTHORAX LOCATION SUBSTERNAL CENTER OR ACROSS CHEST LATERAL CHEST LOCALIZED OVER INVOLVED AREA LOWER CHEST/EPIGASTRIC RADIATES TO JAW, NECK, BACK OR ARM VAGUE

47 PNEUMOTHORAX HISTORY AGE PREVIOUS EPISODES UPPER RESPIRATORY INFECTION/FEVER TRAUMA STRESS EMOTIONAL UPSET CARDIAC DISEASE – HTN, CAD, ANGINA PHLEBITIS

48 PNEUMOTHORAX ASSOCIATED SX / SX DYSPNEA DIAPHORESIS NAUSEA / VOMITING AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE NEURO CHANGES HYPO OR HYPERTENSION OR UNEQUAL BP DECREASED OR ABNORNMAL BREATH SOUNDS CYANOSIS HEMOPTYSIS PULSATING ABD MASS ABDOMINAL PAIN VESICULAR PAIN WITH PALPATION RASH OR LESIONS

49 PNEUMOTHORAX AGGRAVATING FACTORS BREATHING MOVEMENT STRESS EXERTION AFTER EATING OR ETOH LAYING DOWN SITUATIONAL / ANXIETY

50 PNEUMOTHORAX RELIEVING FACTORS REST OR DECREASED MOVEMENT POSITION SITTING UP OR LEANING FORWARD DECREASED OR SHALLOW BREATHING DIET ANTACIDS MEDICATIONS

51 PULMONARY EMBOLISM ONSET/DURATION OF PAIN Sudden Gradual Lasts Minutes Lasts Hours Varies

52 PULMONARY EMBOLISM QUALITY PLEURITIC SPASMODIC TIGHTNESS OR HEAVINESS PRESSURE- OPPRESSIVE SHARP/LOCALIZED VISCERAL/BURNING TEARING / EXCRUCIATING

53 PULMONARY EMBOLISM LOCATION SUBSTERNAL CENTER OR ACROSS CHEST LATERAL CHEST LOCALIZED OVER INVOLVED AREA LOWER CHEST/EPIGASTRIC RADIATES TO JAW, NECK, BACK OR ARM VAGUE

54 PULMONARY EMBOLISM HISTORY AGE PREVIOUS EPISODES UPPER RESPIRATORY INFECTION/FEVER TRAUMA STRESS EMOTIONAL UPSET CARDIAC DISEASE – HTN, CAD, ANGINA PHLEBITIS SMOKING/RECENT SURGERY/BCP (birth control pill)

55 PULMONARY EMBOLISM ASSOCIATED SX / SX DYSPNEA DIAPHORESIS NAUSEA / VOMITING AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE NEURO CHANGES HYPO OR HYPERTENSION OR UNEQUAL BP DECREASED OR ABNORNMAL BREATH SOUNDS CYANOSIS HEMOPTYSIS PULSATING ABD MASS ABDOMINAL PAIN VESICULAR PAIN WITH PALPATION RASH OR LESIONS

56 PULMONARY EMBOLISM AGGRAVATING FACTORS BREATHING MOVEMENT STRESS EXERTION AFTER EATING OR ETOH LAYING DOWN SITUATIONAL / ANXIETY

57 PULMONARY EMBOLISM RELIEVING FACTORS REST OR DECREASED MOVEMENT POSITION SITTING UP OR LEANING FORWARD DECREASED OR SHALLOW BREATHING DIET ANTACIDS MEDICATIONS

58 HIATAL HERNIA ONSET/DURATION OF PAIN Sudden Gradual Lasts Minutes Lasts Hours Varies

59 HIATAL HERNIA QUALITY PLEURITIC SPASMODIC TIGHTNESS OR HEAVINESS PRESSURE- OPPRESSIVE SHARP/LOCALIZED VISCERAL/BURNING TEARING / EXCRUCIATING

60 HIATAL HERNIA LOCATION SUBSTERNAL CENTER OR ACROSS CHEST LATERAL CHEST LOCALIZED OVER INVOLVED AREA LOWER CHEST/EPIGASTRIC RADIATES TO JAW, NECK, BACK OR ARM VAGUE

61 HIATAL HERNIA HISTORY AGE PREVIOUS EPISODES UPPER RESPIRATORY INFECTION/FEVER TRAUMA STRESS EMOTIONAL UPSET CARDIAC DISEASE – HTN, CAD, ANGINA PHLEBITIS

62 HIATAL HERNIA ASSOCIATED SX / SX DYSPNEA DIAPHORESIS NAUSEA / VOMITING AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE NEURO CHANGES HYPO OR HYPERTENSION OR UNEQUAL BP DECREASED OR ABNORMAL BREATH SOUNDS CYANOSIS HEMOPTYSIS PULSATING ABD MASS ABDOMINAL PAIN VESICULAR PAIN WITH PALPATION RASH OR LESIONS

63 HIATAL HERNIA AGGRAVATING FACTORS BREATHING MOVEMENT STRESS EXERTION AFTER EATING OR ETOH LAYING DOWN SITUATIONAL / ANXIETY

64 HIATAL HERNIA RELIEVING FACTORS REST OR DECREASED MOVEMENT POSITION SITTING UP OR LEANING FORWARD DECREASED OR SHALLOW BREATHING DIET ANTACIDS MEDICATIONS

65 GASTROINTESTINAL ONSET/DURATION OF PAIN Sudden Gradual Lasts Minutes Lasts Hours Varies

66 GASTROINTESTINAL QUALITY PLEURITIC SPASMODIC TIGHTNESS OR HEAVINESS PRESSURE- OPPRESSIVE SHARP/LOCALIZED VISCERAL/BURNING TEARING / EXCRUCIATING

67 GASTROINTESTINAL LOCATION SUBSTERNAL CENTER OR ACROSS CHEST LATERAL CHEST LOCALIZED OVER INVOLVED AREA LOWER CHEST/EPIGASTRIC RADIATES TO JAW, NECK, BACK OR ARM VAGUE

68 GASTROINTESTINAL HISTORY AGE PREVIOUS EPISODES UPPER RESPIRATORY INFECTION/FEVER TRAUMA STRESS EMOTIONAL UPSET CARDIAC DISEASE – HTN, CAD, ANGINA PHLEBITIS Maybe none…. For example, food poisoning doesn’t require a history other than recent eating.

69 GASTROINTESTINAL ASSOCIATED SX / SX DYSPNEA DIAPHORESIS NAUSEA / VOMITING AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE NEURO CHANGES HYPO OR HYPERTENSION OR UNEQUAL BP DECREASED OR ABNORNMAL BREATH SOUNDS CYANOSIS HEMOPTYSIS PULSATING ABD MASS ABDOMINAL PAIN VESICULAR PAIN WITH PALPATION RASH OR LESIONS

70 GASTROINTESTINAL AGGRAVATING FACTORS BREATHING MOVEMENT STRESS EXERTION AFTER EATING OR ETOH LAYING DOWN SITUATIONAL / ANXIETY

71 GASTROINTESTINAL RELIEVING FACTORS REST OR DECREASED MOVEMENT POSITION SITTING UP OR LEANING FORWARD DECREASED OR SHALLOW BREATHING DIET ANTACIDS MEDICATIONS

72 PNEUMONIA/PLEURISY ONSET/DURATION OF PAIN Sudden Gradual Lasts Minutes Lasts Hours Varies

73 PNEUMONIA/PLEURISY QUALITY PLEURITIC SPASMODIC TIGHTNESS OR HEAVINESS PRESSURE- OPPRESSIVE SHARP/LOCALIZED VISCERAL/BURNING TEARING / EXCRUCIATING

74 PNEUMONIA/PLEURISY LOCATION SUBSTERNAL CENTER OR ACROSS CHEST LATERAL CHEST LOCALIZED OVER INVOLVED AREA LOWER CHEST/EPIGASTRIC RADIATES TO JAW, NECK, BACK OR ARM VAGUE

75 PNEUMONIA/PLEURISY HISTORY AGE PREVIOUS EPISODES UPPER RESPIRATORY INFECTION/FEVER TRAUMA STRESS EMOTIONAL UPSET CARDIAC DISEASE – HTN, CAD, ANGINA PHLEBITIS

76 PNEUMONIA/PLEURISY ASSOCIATED SX / SX DYSPNEA DIAPHORESIS NAUSEA / VOMITING AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE NEURO CHANGES HYPO OR HYPERTENSION OR UNEQUAL BP DECREASED OR ABNORNMAL BREATH SOUNDS CYANOSIS HEMOPTYSIS PULSATING ABD MASS ABDOMINAL PAIN VESICULAR PAIN WITH PALPATION RASH OR LESIONS

77 PNEUMONIA/PLEURISY AGGRAVATING FACTORS BREATHING MOVEMENT STRESS EXERTION AFTER EATING OR ETOH LAYING DOWN SITUATIONAL / ANXIETY

78 PNEUMONIA/PLEURISY RELIEVING FACTORS REST OR DECREASED MOVEMENT POSITION SITTING UP OR LEANING FORWARD DECREASED OR SHALLOW BREATHING DIET ANTACIDS MEDICATIONS

79 HYPERVENTILATION/ANXIETY ONSET/DURATION OF PAIN Sudden Gradual Lasts Minutes Lasts Hours Varies

80 HYPERVENTILATION/ANXIETY QUALITY PLEURITIC SPASMODIC TIGHTNESS OR HEAVINESS PRESSURE- OPPRESSIVE SHARP/LOCALIZED VISCERAL/BURNING TEARING / EXCRUCIATING VAGUE/DIFFUSE

81 HYPERVENTILATION/ANXIETY LOCATION SUBSTERNAL CENTER OR ACROSS CHEST LATERAL CHEST LOCALIZED OVER INVOLVED AREA LOWER CHEST/EPIGASTRIC RADIATES TO JAW, NECK, BACK OR ARM VAGUE

82 HYPERVENTILATION/ANXIETY HISTORY AGE PREVIOUS EPISODES UPPER RESPIRATORY INFECTION/FEVER TRAUMA STRESS EMOTIONAL UPSET CARDIAC DISEASE – HTN, CAD, ANGINA PHLEBITIS

83 HYPERVENTILATION/ANXIETY ASSOCIATED SX / SX DYSPNEA DIAPHORESIS NAUSEA / VOMITING AMS /WEAKNESS / LIGHTHEADEDNESS / SYNCOPE NEURO CHANGES HYPO OR HYPERTENSION OR UNEQUAL BP DECREASED OR ABNORNMAL BREATH SOUNDS CYANOSIS HEMOPTYSIS PULSATING ABD MASS ABDOMINAL PAIN VESICULAR PAIN WITH PALPATION RASH OR LESIONS INCREASED RESP RATE NUMBNESS –EXTREMITIES/FACE

84 HYPERVENTILATION/ANXIETY AGGRAVATING FACTORS BREATHING MOVEMENT STRESS EXERTION AFTER EATING OR ETOH LAYING DOWN SITUATIONAL / ANXIETY

85 HYPERVENTILATION/ANXIETY RELIEVING FACTORS REST OR DECREASED MOVEMENT POSITION SITTING UP OR LEANING FORWARD DECREASED OR SHALLOW BREATHING DIET ANTACIDS MEDICATIONS DECREASED ANXIETY

86

87 And now…. It’s time for Call Type of the Month!

88 Will/Grundy Call Type of the Month Fall call! Not this kind….This kind!

89 Most important thing to remember: Falling is a symptom, not a complaint. There is always a reason why they fell. Tripped Dexi Dizzy Dead Etc. Will/Grundy Call Type of the Month

90 Fall assessment is targeted toward determining and treating associated injuries and possible causes – as well as ruling out pertinent negatives. Narratives/PCR’s need to reflect this process. This is not enough: “Called to 62yo female a&ox3 but lethargic, laying in bathroom, 1 in. lac r temple. Bleeding ctx w/4x4. Pt c/o upper back pain. Family sez they fall a lot. Pt board/collar, vitals as per below, head-to-toe, etc, etc, etc….” Will/Grundy Call Type of the Month

91 EMS crews need to provide clues from the scene to help ER staff answer the question: Why did this patient fall? Was it sugar? Cardiac? Blood pressure? Heat? Rug needs to be taped down? Better: “Called to 62yo female a&ox3 but lethargic, laying in bathroom, 1 in. lac r temple. Bleeding ctx w/4x4. Pt c/o upper back pain. Family sez they fall a lot. Pt stated she felt dizzy as she got up from commode. Pt states she often feels dizzy in the mid-morning. Crew notes pt BP is lower than BP recorded by home CNA in am. Pt board/collar, head-to-toe, etc, etc, etc…”

92 Will/Grundy Call Type of the Month Absolutely no idea why they fell? Well, if after a thorough assessment and treatment you have no clues to report, then stick to the pertinent negatives: Example: “Called to 62yo female a&ox3 but lethargic, laying in bathroom, 1 in. lac r temple. Bleeding ctx w/4x4. Pt c/o upper back pain. Pt states does not remember falling. Family unable to offer hx due to lang. barrier. Crew notes no obvious slip/fall hazards in bathroom. Etc, etc, etc…...”

93 Will Grundy Call Type of the Month Summary: Many fall calls need ALS care. It’s tempting at 2am to just board, collar and transport. But there is always a reason why they fell. We are the eyes and ears of the doctor on the scene. So we need to gather clues during the assessment process.

94 Thank you!


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