RAMI Pelvic Trauma Case Study

S.P. is admitted to the orthopedic ward. She has fallen at home and she has sustained an intracapsular fracture of the hip at the femoral neck. The following history is obtained from her: She is a 75-year-old widow with three children living nearby. Her father died of cancer at age 62; mother died of heart failure at age 79. Her height is 5’3 and weighs 118 pounds. She has a 50 pack year smoking history and denies alcohol use. She has severe Rheumatoid Arthritis (RA) and had an upper GI bleed in 1993 and had Coronary Artery Disease with CABG 9 months ago. Since that time, she has engaged in “very mild exercise at home.” Vital signs are 128/60, 98, 14, 99 degree farenheight (32.7 degrees C) SAO2 94%

Jane was involved in a single-vehicle accident that resulted in multiple areas of injury from a head trauma, two broken ribs as well as bilateral fractures in her leg’s as well as right arm and wrist fracture. Jane was, transported a hospital that was an hour and half away from her home.

Initially we had difficulty obtaining his discharge orders as the hospital care manager replied she had forwarded the documentation, but neither I nor Mrs. Bianco had received a copy. Mrs. Bianco made a visit to Mills Creek and met with Mr. Smith at that time she was made aware of an appointment that Mr. Smith attended. Mr. Smith attended a physician appointment on June 28, 2017 with Dr. Leonard, Orthopedic trauma. Mills Creek assisted with the transportation and a mobile x-ray unit was coordinated to obtain x-rays of the femur at the facility as Mr. Smith didn’t bring his slide board to the appointment and couldn’t get onto the radiology table.

“Thirty-five year old Donna Duckworth is learning how to care for her newborn of five weeks, when she bends over the baby’s crib and feels something give in her back. The next day and the following week, the pain becomes unbearable in her back. She is breast-feeding and does not want to take any medication so she lives with the intense and continuing pain. Within a few weeks, she can no longer stand it so she goes to see her physician who orders blood work, does a complete physical and as a result, sends her to see an orthopedist who x-rays and does a bone density study. The diagnosis comes back as osteoporosis and it is found she has fractured three of her lumbar and four of her cervical vertebra.”

I. Theoretical and Research Basis for Treatment While working with Precious it has become clear that she has gone through a number of traumas as a child and up until her young adulthood. Precious, dealing with both sexual and physical abuse, has come a long way in wanting to seek treatment and actually wanting to move past her previous traumas. Relevant treatment choices for Precious would be Eye Movement Desensitization and Reprocessing (EMDR) Trauma focused cognitive behavior therapy Exposure therapy Cognitive Processing Therapy Integrative treatment of complex trauma for adolescents.

When she was sent for an X-ray it showed that she had some swelling, but not a fracture. Dr. Scott advised her to think about having reconstructive surgery, which she followed through with. Part

I met Mr. Eigner at the office of Dr. Taha. Mr. Eigner reports he is not taking any pain medications at this time. He reports he has a jolting shooting pain to the right and left legs only occasionally. He denied any pain to his right forearm. X-rays taken showed good alignment and healing of the fracture. The incisions are all healed except for a couple small spots on the right ankle. There is some swelling to the right ankle which Dr. Taha said is to be expected. The range of motion to the left ankle and toes was good. The range of motion to the right stores was limited. Dr. Taha said there is scar tissue at times from this type of repair and he would like physical therapy to start working on that. He is still going to be non-weight bearing for another 6 to 8 weeks on the right leg. He is now allowed full weight bearing as tolerated to the left leg. Dr. Taha ordered a rolling scooter to aid with ambulation and stop using the wheelchair. I have contacted Reverence physical therapy and faxed the new orders so the service can begin. I will process the rolled scooter with directions from the adjuster. The attendant care and replacement services will continue through to the next appointment.

Indications: The patient is a 69 year old black female who fell landing on her right hip. She was seen in the Emergency Room where physical exam and x-ray revealed an intertrochanteric right femoral fracture. She was admitted to Dr. Loyd’s service .

May 18th 2014 Mr. Beaird fell and broke his hip. This followed hip surgery performed by Dr. Baker and 21 day rehabilitation form Cordova NH. Before his 21 days was up Mr. Beaird tried to break out of NH by running his scooter though the front door at the NH. When the scooter hit the door, the door opened and Mr. Beaird rolled onto the front porch during this altercation, his foot was injured and the ambulance was called. Mr. Beaird was admitted to Senior Care and diagnosed with a

     The medical staff role in the care of trauma c-spine injuries is to make sure that proper exams are done so that a proper diagnosis can be made. This is achieved by a good physical assessment as well as proper communication with the EMT’s about mode of injury, and evaluation of radiographs that have been ordered. If the radiographs are inadequate to rule out a fracture, then the need for repeated or additional X-rays or a CT scan should be obtained, until all vertebrae are visible and the possibility of fracture can be ruled out. This is how it is supposed to work.

INDICATION: Fracture occurred when the patient was involved in an unspecified motor vehicle collision. It is known that Mr. Blake was the driver of the vehicle.

Ms. Payne has not had any follow up appointment this reporting period. She has attended counseling appointment’s to talk about her anxiety and panic related to the accident. She felt she will be done with her counseling soon. Physical therapy has been completed for the shoulder, the knee and she has a home exercise program. She also has completed using attendant care for assistance with bathing and light house work. I anticipate that this file is close to

He was more agitated and less responsive overnight. He had ecchymosis on the left clavicle with discomfort when the left arm was attempted to move. Laboratory results dated 12/01/2017 showed low levels of hemoglobin at 11.5, hematocrit at 33.6, potassium at 3.3, calcium at 8.3, and RBC at 3.92 with an elevated WBC at 12.8. He was diagnosed with a pulmonary contusion with multiple rib fracture and left-sided nondisplaced clavicle fracture secondary to fall and acute encephalopathy likely secondary to fall. The claimant agreed to be transferred out of

Ms. Tocco was a passenger in her husband’s vehicle. They were T-boned on her side of the vehicle. Pictures of her vehicle showed the passenger side of the vehicle indented from the front bumper to the rear bumper. The seat she was sitting in was crushed and had a large vertical dent in the seat. She was taken to Henry Ford Clinton Township hospital where she was for 5 days.

On 4/4/17 I met Mr. Kobetic at the office of Dr. O’Hara Neurosurgeon. Mr. Kobetic reports he has no back pain. He is allowed to remove the back brace for sleeping and reports his left side muscles are tender when he is lying in bed. X-rays were taken before the appointment today. Mr. Kobetic was examined by PA Ms. Masaud then Dr. O’Hara came in. Examination showed good strength, sensation and strength. The x-rays showed the fracture has healed. Mr. Kobetic may now remove the back brace. He is to increase his activity as tolerated. Mr. Kobetic will follow up with the office only if needed. Mr. Kobetic will be making the stress test appointment with the cardiologist to determine if he had a cardiac issue that caused the auto accident. Mr. Kobetic reports he has no recollection of the accident and what caused it. Once the test is complete and he has a follow up appointment he will let me know. Mr. Kobetic returns to work today.