Short post based on a real call. Something to get the brain juices going a tiny bit.
You were watching the basketball finals in a gymnasium. Both teams had played great, the game had ended and you were just about to leave when you notice a lady on the ground by the bleachers. You decided to ask if she’s doing okay.
You: “Hi, are you all right?”
Lady: “Yeah…I just slipped and fell down the bleachers. My leg is sore though.”
You: “I’m an off duty paramedic, would you like me to take a look?”
Lady: “Sure thing.”
The lady with some help from her husband stands up and sits on the bleachers. You find out that she didn’t hit her head or lose consciousness and that she placed her hands out as she fell. You notice that she’s a lady with a bigger build, easily 230lbs at a height of about 5’5. She seems like a nice person and is very polite.
Lady: “I’m so clumsy, I can’t believe I just fell. I hurt my left ankle last week.”
You: “Oh, that’s no good. I suppose this isn’t the best way to finish the evening.”
You roll the lady’s pants up, you are greeted by legs that are quite edematous and there appears to be some varicose veins. The veins bulge out at you and you can make out exactly where the valves are all located.
Lady: “It’s just the right leg, it’s kind of sore in the lower calf by the ankle.”
You notice some bruising had started to form around the area. There are good pulses and movement, no looseness of the ankle joint. You compare the injured leg to the uninjured and the injured one was definitely a bit more swollen. Despite that, there doesn’t seem to be any significant injury.
You: “Your legs are a bit swollen, are your legs normally like this?”
Lady: “Yes, it’s always been like this.”
You: “Do you use pressure dressings for the swelling?”
You: “I notice you have some swollen veins here, are you diagnosed with varicose veins?”
Lady: “No, I’ve never talked to my doctor about it.”
You further examine the injured area and notice her right calf is quite hard compared to her uninjured side. The lady says it is very tender over the hematoma and it worsens quite a bit when she walks (uses her gastrocnemius and soleus muscles). The lady says she has had no other injuries to that leg before. You are curious about her swollen legs and inquire if she’s had any heart conditions (for example CHF), diabetes, or any other medical conditions. She denies any of the above conditions but says she’s had cholecystitis, has mildly high blood pressure and that she’s had a minor stroke before in the past from a clot.
You: “Did the doctor say what caused the clot?”
Lady: “Yeah, it was because I was on the pill. I’ve stopped taking the pill ever since.”
You: “Do you take aspirin?”
Lady: “Not regularly, it’s not prescribed to me”
You make a final note that she’s not allergic to anything and that she’s not taking any medications aside from aspirin occasionally and tylenol for her left ankle injury last week. Her vitals are normal. Now you’ve gotten to the part in your patient assessment where you come up with a treatment plan. It seems like a simple case. Patient accidentally slipped and fell down two flights of bleachers. She did not hit her head and did not lose consciousness from the incident. Only injury noted is the hematoma forming on her right calf, which is hard on palpation. Looks like a bruise. Yet you are slightly hesitant to tell her to go home and just put ice on her leg (or maybe you’re not). Why is that? What are some possible concerns floating through your head? What would the best treatment plan be?
Feel free to post what you think in the comments section, would love to hear your thoughts. I will follow this up with a second post.