Scenarios‎ > ‎

Scenario 1

Shoulder Dislocation

GENERAL SCENARIO DESCRIPTION
Just up the hill from the fire house, a novice mountain biker loses control and does a tumbling fall, causing bike and gear to go flying in all directions. Sometime during this fall s/he puts an arm out to brace the fall, and a shoulder dislocation results.

INFORMATION GIVEN TO TRAINEE
Dispatch: Received a call to respond to an injured biker near bottom of the nearby hill. You're told it looks like a "yard sale".

PATIENT SUMMARY
The lower arm is rotated outward, and there is resistance to trying to rotate it toward the body. It is most comfortable secured in that position with padding between the upper arm and body. No loss of sensation.

SCENARIO OBJECTIVES
Assessment:
  • Verify scene safety; obtain permission to assist
  • Primary assessment reveals deformity at the shoulder
  • Secondary assessment, no other injuries found
Problem Management:
  • Pain management (calming, position of comfort)
  • Patient frustrated by language communication challenges
SPECIFIC INSTRUCTIONS FOR PATIENT
Position: You are sitting with your upper arm close to your body, elbow flexed, and lower arm held pointing forward. You are holding the elbow of that arm with your other hand to support it.

Answers to SAMPLE:
Signs and symptoms: shoulder pain and deformity
Allergies: none
Medications: none
Past history: you have dislocated your shoulder "a couple of other times"
Last meal: report actual
Events leading: you were on a slope that was too steep and lost it, taking a tumbling fall. Somewhere in the fall you felt the shoulder go.

Behaviors: You are holding your arm. You tell the trainee who arrives that you've done this before, and all they have to do is "just pull on your arm and it will pop right back in." You ask the trainee if s/he can do this, but accepts the trainee’s refusal to pull on arm. You do not want them to try and rotate your lower arm inward so that they can use a standard sling. That movement causes increased pain. You are most comfortable if the arm is secured with padding between the body and upper arm, and lower arm left in the original position. 

SPECIFIC COMMENTS FOR EVALUATORS
A bystander who was biking with the patient (and also speaks only Spanish) could be directed to collect the "yard sale" items.

Source: derived from National Ski Patrol
Comments