Treating a broken ankle - did I get it right?

[Scruit]

Sorry this is so epically long. Gotta get it off my chest.

This morning I was rollerblading with my son at the local skating rink when I saw a lady who had fallen. Considering how often people fall I always give someone one full lap to get back up before I check on them. That's about 20-30 seconds. Next lap I saw she had someone with her and was just talking but still on the ground. By the third lap I decided to check in and make sure she was ok. She wasn't.

She said she had broken her ankle, and I told her I was a first aider (Thanks Todd!) and asked if she wanted my help, which she accepted. I took my blades off and started to examine her ankles. She had already removed her rollerskates and was in her stocking feet. She was in an extreme amount of pain and struggled to move at all. I found her right ankle to be heavily swollen already, obviously at least a grade 2 or 3 sprain. She had a girl with her who said she was "studying medical at OSU" and another guy who was wearing a fire department t-shirt for a nearby department.

I offered a couple of suggestions for getting her off the rollerskating floor (bringing over a chair, having her sit in the chair and FD guy and myself carry her in the chair. Or we could just carry her from either side in a side lift. She declined both) I told her I was going to get a cold pack. Ran out to my car and got my first aid kit, where I have an emergency cold pack. FD-shirt guy offered to call 911 when it became clear it would be too painful for her to make it outside and into a car. The lady agreed and he disappeared to make the call.

As I got back with my first aid kit I found she had crawled across the floor and was sitting on a bench. I had her lie down and put her leg up on the backrest, the asked her which way she twisted her ankle. She said inwards (suggesting an inversion injury) but that didn't seem right to me because all the heat from the swelling was on the inside of her ankle (suggesting an eversion injury). My coldpack wasn't big enough to cover both sides so I opted to place it on the inside where the swelling was, leaving her thin sock on. Any contact here was very painful for her, as was any movement, so I got myself into a position where I could hold her lower leg and ankle dead still without fatigue on myself or her and still be able to apply the cold pack with light enough pressure to not cause pain. After 15 minutes I moved the cold pack to the outside of her ankle for fear of too much cold causing more problems - any touch on her outside ankle was agony to her - another suggested of an eversion injury in my mind.

During the time she kept asking me; "Is it bad?" and "It's really bad, isn't it?" to which I replied that an ankle sprain is the most painful thing I have gone through myself, and I've done it a couple times and both times I have recovered fully, so I told her she was going to be fine. Of course, I was being slightly economical with the truth in that I was talking in the long-term - I could tell from my angle that he ankle had definitely been broken badly (her ankle was clearly misaligned outwards, further suggesting an eversion injury, and when she moved her ankle ever-so slightly it clicked/cracked in my hand like a bag of rocks). My non-medical opinion was that I heavily suspected a trimalleolar fracture that would require surgery to screws/plates to repair and up to 12 weeks recovery time. But after all that she'd be fine, so I stuck with "We'll get you up to the hospital so you can be treated and you'll be fine."

When the squad arrived I gave them the download of her injury, her assement of the injury, my observations of the misalignment and where the pain seemed to be including my suspicion it was an eversion not inversion injury, and I kept the cold pack on as long as I could until they got her lower leg into an air splint and we all helped her into the chair. All this time I was reassuring her, and her two daughters. Someone else had called her husband to pick up her daughters, both 10-11yo, very upset at what was going on.

They whisked her away into the ambulance and within seconds it seemed like, it was all over and done with and I was left sitting there holding a half-used coldpack, her sock that EMS cut off her (I left it on so I'd have something between the cold pack and her skin, it was very thin) And then that was it. Every went back to skating (TBH only 3 or 4 stopped). It's a pretty empty feeling once it's all over because you get the adrenaline rush of trying to help someone who is clearly in a great deal of pain so you're trying help as best you can without making things worse, so you're second-guessing yourself, struggling even with simple tasks like breaking the inner bag on the coldpack - am I doing this right, why won't it break? Read the instructions, figure out that although I just READ the instructions my brain didn't get them so have to read them again. I actively chose not wrap the ankle in ace bandage for compression because she was in a great deal of pain with anything touching her ankle - we couldn't even take her thin sock off because of the pain, so wrapping would have been too painful.

So now she's off to the hospital and she'll recover in time (will be a long road). I'll never hear back again, so I'll never know if what I did helped or not. I'd like to think that focusing so much on helping her ankle also helped her deal with it emotionally.

Another strange thing was a member of staff approached me while I was holding the coldpack on the lady's ankle and asked ME for the lady's name - I said I haven't the slightest clue what her name is! (note to self, introduce first names next time) The staff member struggled with this concept and asked; "Aren't you with her?" "No, I'm just helping because I have a first aid card and medical supplied with me".

So, for you medical / FF / EMS types - did I do everything right? Did I mess anything up? Anything I missed?

- I did introduce myself and tell her I was trained in first aid and asked her permission to help her.

- Every time I did anything I told her first / asked her permission (things like moving the coldpack, pulling up her sock to provide a little insulation on the coldpack. She was in a lot of pain but was a great patient.

- The EMS team offered to replace the supplies I used from my kit which was nice.

- I asked the guy in the FD shirt if he was a firefighter (the best trained person should be in charge of the medical aid, so I figure if he was a FF he would be the guy to do it) but I thought his response was weird, words to the effect of "I used to be, sort of" and then he kind of milled around proving non-medical assistance.

[ScubaCinci]

I can't answer your question but good for you for helping. I'm wary about helping people with any non-emergency injury like that because a) I have no medical training b) there are too many litigious people and I'd be leery of lawsuits.

[Scruit]

I've done the red cross first aid course a few times over my life, as well as first aid training in the UK Scouts, US Boy Scouts, UK Army Cadets etc, and I have a current red cross card. I acted entirely within the scope of my training, and have no fear of anyone suing me.

Fingers crossed.

[ReconRat]

She might have thought ankle inward or foot inward. 50-50% response.

You did good.

[Scruit]

I think part of her problem was a combination of 1) using rented rollerskates that have little ankle support and allowed her to put her foot in a position where she could sprain it, and 2) her weight which exacerbated the injury.

I wish she'd left the rollerskate on - she must have been in agony taking it off. I would certainly advised letting EMS remove it. Also, some people recommend RICE (Rest, Ice Compression, Elevation) which is what I did (except compression, as the pressure would have been too painful for her. Plus EMS was en route). other people recommend MICE (replacing Rest with Motion,specifically dorsiflexion) but ad the misalignment of her ankle suggested a break rather than a simple sprain, I opted to avoid any movement of the foot.

[MidgetTodd]

Lol you did more than I would've, even if I was on duty and on the squad that picked her up so yea, you did fine.

Ankles, I usually just take em in to ER nothing we do on the squad will change the outcome and ER generally likes to see position and swelling for their assessment so I don't bother and field interventions such as cold packs ect won't do much if anything for pain. So watch for shock and talk to them is really all Ill do. If its obvious they'll go straight to surgery I'll start an IV which you couldn't have done anyway. So yea you did it it right and overachieved. Talk to them and watch for shock. I rarely worry about calling my patients by name unless they are hysterical or combative.

The FD shirt guy, we call them squirrels. He probably got it for helping a volunteer dept with a fund raiser and now wears it everywhere to feel special or try for discounts. I've probably got 20 shirts from the FD with my name, number, rank on them so you can tell they are legit and how often have you seen me wear them? I wear my pullover occasionally because its warm that's about it. If I'm not on duty I rarely wear the clothing because I don't need the shirt to make me fel good, I know what I've accomplished so I don't need the shirt. Most that wear them are not active members or much less certified. The ones that are don't show it because we get asked to look at baby's BooBoo or listen to Grammys cough ect everywhere we go and it gets old.

You did fine

[Anden]

Better start checking the missed connections part of craigslist. She will be hunting you down. Or the Village People tribute guy. Never know.

Good on you for helping her out.

[shadyone]

How has no one asked to see VIDEO. this is Scruit for gods sake. You're all slipping.

[Scruit]

I figured I'd bring this back up and compare my untrained response with what I would do *now* since I completed my EMR training course.

 

Differences would be:

 

- ABCs are good as I can talk to her, she is not reporting any breathing difficulties, she has good perfusion, she's Alert on AVPU and A&Ox4 - just need to watch for the unlikely event of hypovolemic shock (bleeding inside the leg) or psychogenic shock (from fear/pain).  

- Would probably splint rather than ice the ankle if I had access to non-improvised splints that I didn't mind losing (sam splints in a stirrup configuration maybe?), else I would hold manual stabilization knowing EMS would use their own splints in place of anything improvised (probably a vacuum splint).  Don't want to put her through splinting twice if I could help it.

- Would check the anterior tibial or pedal pulse plus motor and sensory function in the foot (big toe, top of foot) prior to and after splinting, if I chose to splint.  Otherwise just check once and be ready to report any loss of P/M/S function to the EMTs as soon as possible. I'm not able to address any deficiencies. 

- Would have her lay supine on floor with both legs elevated to help with both shock risk and also to reduce the blood pressure in the broken ankle.  I know what happens when you take an elevated broken ankle and put it back down to the floor - it was the worst pain I've ever been through in my life).

- Originally she was laying on a padded bench which was nice and comfy but required he to sit up and lower her injured foot so she could swing around and be helped up onto the cot.  I think a better option would be to have her lie on the floor where there is enough room to get her on a backboard to loading into the cot, allowing her ankle to stay at body level and hopefully reducing her pain.  Todd?

- Would also request a blanket from the business or coat from bystander to keep her warm and for shock management.

- Would keep her talking and keep an eye on her level of consciousness.  Possibly take blood pressure if she shows any sign of diminished level of consciousness or any other symptoms or shock like cool clammy skin/hypoperfusion, but as I won't have access to EMT gear like oxygen I've already exhausted my shock management options with heat/raised legs/supine so that would simply be noted for EMS.

- With no significant mechanism of injury there's not much else to do but keep her as comfortable as possible, manage shock risk and stabilize the ankle to prevent any further harm/reduce pain as much as possible and wait for the EMTs.  

 

Did I win a cookie? 

[Bad324]

Duct tape it and walk it off

[Casper]

Duct tape it and walk it off

Duct tape and paint stirs.

[Scruit]

Duct tape and paint stirs.

 

Make sure the duct tape sticks to the hairs, and the stir sticks were recently used for aircraft grade paint stripper??

[rawlins87]

Tl:dr

[Gixxus Christ!]

Good on ya. I was certified red cross first aid and cpr some 20 years ago in the boy scouts but have let my card lapse. I still remember most of my training and have had to administer aid to myself, my fiancé, nieces and nephews, coworkers and one stranger. Sounds like you did what you could. The fact only a few people stopped to check on her says a lot about our society today.

[jbot]

you forgot the complimentary boobie touch for being a good helper