Friday, 22 March 2013

The happy Space Hopper

Aww, bless her. She went through a lot of pain and yet allowed me to write this story up. This is Laura and she had an accident.

If you look closely at her right elbow you'll see it's not quite the right shape or size. In fact, she's fractured and dislocated her Humerus so badly that the Radius and Ulna (the lower arm bones) have detached completely and slid upwards and behind the upper arm. This photo was taken by her boyfriend 'Brummy' while she was being treated.

We were called to a 'possible dislocated elbow' and managed to get to the address without being cancelled or diverted (which could easily have happened as it was a very busy night for drunks and they, as always, take priority over broken bones).

When we got into the flat, Laura was on the floor and her boyfriend and three others were around her. There was a bit of giggling going on because alcohol had been imbibed (responsibly in this case) and they were all good mates who thought this was awkward and rather amusing, which it was at times. Although having broken a bone myself, I sympathise completely with the general feeling in the room - you know, if we don't laugh, we'll cry... that feeling.

My crew mate and I started putting her at ease and I explained that I'd give her a little pain relief. She was quite drunk - not stupidly so, but enough to keep her grounded while all this was going on and her arm looked pathetically useless to her. So, I gave her a little morphine and a LOT of Entonox. She was perfectly capable of self-administering the gas and it helped her a lot. So much, in fact, that she was positively bursting with happiness at times. She was like a giggling crippled starfish on that floor.

This was going to be an awkward removal because the flat was a couple of flights of steps up and walking her out was our only option. My crew mate, who is a student paramedic, had never seen such a  serious fracture/dislocation, so I spelled out the plan so that we could move her safely and without causing any further harm if possible. It was not going to be easy.

After a bit more gas and a bit more reassurance, and with all her friends settled down to the reality of her condition, we began to move her from the floor to the ambulance. We had no vacuum splints, which would have been ideal, so I made do with a box splint and padding when I got her out of the flat. Holding her arm stable whilst walking with her was the only realistic option we had, given the position she was in, the position her arm remained in and the environment we had to negotiate.

It was a long, slow and careful process. I felt the bones of her arm shift only once during the move; there was a bit of a crunch as they ground together (crepitus) but it wasn't allowed to happen again.

As soon as she was safely in the ambulance, we packed her arm into the splint and positioned Brummy so that he could keep it stable during the slow drive to hospital. He was more than happy to help and assisted with humour and smiles for Laura. That's the way it should be really. She was in pain and she had a fairly serious injury, but it wasn't life-threatening and she needed to be kept up-beat so that she could bear it.

She told me she'd had several fractures in her life; she seemed prone to them when she had the most benign falls. I suggested she may want to investigate the possibility that she had EDS, or another condition that was causing this.

We popped in to see them both in the Resuscitation Room, where they'd been taken so that Laura could have the dislocation reduced. They were in good spirits (well, Laura was mostly off her head on drugs by then).

The arm was reduced but it failed and the plaster had to be cut open and another attempt made. For a good few hours the poor girl went through painful and uncomfortable procedures to make her joint behave. It finally settled into its anatomical position on the second reduction and re-plaster.

The X-ray shows the extent of the dislocation. Laura had to return to hospital to have bone fragments cleaned out and may have to have pins put into the joint.

And how did she manage to do all this? Well, you are already thinking she was hopping about drunk and fell off the big rubber ball... but you're wrong. She was hopping about, as were the others, having a laugh and enjoying a dinner party with friends, but she successfully completed her hopping fun and dismounted. She then took a few steps around it and fell to the floor so awkwardly that she did the damage that now renders her temporarily disabled.

Crazy huh?

They had been drinking, yes... but in the privacy of a friend's home. They had been fooling about on a big inflated ball whilst a little drunk, yes... but they were having a dinner party and it was that or Charades. They called an ambulance, yes... but they needed one. This is a genuine accident and there was a real injury. Not one of these people went out to get so drunk they'd end up in a gutter, vomiting their stomach inside out. They were, in fact, pretty sensible, decent and thankful individuals. Brummy had even been preparing to take his injured girlfriend to hospital in the car, rather than 'waste our time'. I can tell you right now that her injury would have been much worse by the time she'd reached hospital if they hadn't called 999.

My sincere thanks to Laura and Brummy for their permission to highlight this call and for their great sense of humour and common sense. I wish Laura the very best of luck with her recovery, and I'll keep you all posted.

* With respect to recent emails. Can I just clarify once again that Laura gave me express permission to use her name, so she has no objection whatsoever to having her name seen on this x-ray! The photo was taken by Brummy specifically for use here! Thank you.

Be safe.


Golden Psych said...

Owwwwwww! I broke my elbow when I was a kid by falling off my bike and it was awful. I was told because of the way in which it was fractured they couldn't plaster it so only had a pink sling. I remember the pain being horrendous and looking at this makes me feel sick remembering it.

To say that though. You can't help but laugh as well.

Anonymous said...

Ouch! I spent 8 hours in a&e in north london with a friend last year for the same sort of accident - night out but early on in the night before too much alcohol had been consumed, friend slipped and fell and had a pretty identical injury. Even with morphine & alcohol, hearing a grown man scream when the hospital tried to put him back together was enough to put me off ever wanting to do this kind of injury!
Been reading your blog for quite some time now & find it extremely interesting, glad to see you back :)

Anonymous said...

Great post! Just out of curiosity, how did you box splint her arm? Was it just letting her put it at an angle she was comfortable with or was it at a 90 degree angle or something? Hope your well


Xf said...

I pretty much held it in there at the angle she wanted to hold it at. It wasn't ideal but it did the job.

merinz said...

You make an interesting point in this article - many people dont think it through when they decide to take a person to emergency in their car. The patient can end up in a far worse state as a result. Much better to have ther peson stablised and transported in an ambulance.

FxckFest said...

love your blog, it is really well written and this post is really informative :) ( I am a memeber of the Irish Red Cross myself, so i know afew things about first aid!)

Anonymous said...

Hi... Can totally sympathise. I broke a leg when I was 9. My sister didn't believe me because I wasn't crying. I guess the shock kind of numbed me. So happy you guys were there to help. I kind of know what it means to be driven in the back of a pickup over country roads with a cardboard box as a splint. You should have seen the doctor's face. It was a twist break (right through) and I stood on it afterwards! Thanks for what you are doing for us, and for your blog;)

SOS Medecin Casablanca said...

i found this article very helpful thank you :)