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Help?! Curious about big falls and the care received afterwards in the ER?! Any docs out there??

Original Post
Oliver Clothesoff · · Unknown Hometown · Joined Dec 2007 · Points: 0

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Mathias · · Loveland, CO · Joined Jun 2014 · Points: 306

I have not been to the ER for any climbing related injuries, but I have been to the ER once or twice.

They may well be thoroughly checking you out for your own safety and well being. But they are CERTAINLY putting you through any and all tests to ensure they cover their own asses! And the fact that they make a profit from those (justifiable) tests, is not unlikely to be a factor in their motivations.

FrankPS · · Atascadero, CA · Joined Nov 2009 · Points: 275

Why don't you see your primary care physician and ask him?

Doug Meneke · · Unknown Hometown · Joined Apr 2013 · Points: 10

The biggest issue is internal bruising, bleeding, etc. Those tests will show that.

wing thing · · Unknown Hometown · Joined Jun 2013 · Points: 90

Studies performed are tailored to the patient's symptoms, exam, history, and mechanism of injury, among other things. MRI's aren't typically performed because they require more time to perform and may not be readily available. Not all spinal x-rays are performed if the patient can be cleared clinically with clinical decision rules. Serial ultrasound exams of the abdomen can be performed fairly quickly. The patient may often be observed in the emergency department for hours for repeated examinations in lieu of admission or more aggressive studies.

CT scans are not done head to toe typically in patients because: 1) You focus on what the CT is best for determination of particular injuries such as head, spine, chest, abdomen. 2) CT's expose the patient to a lot of radiation. 3) Regular x-rays are cheaper and expose the patient to less radiation for images of extremity injuries. Performing a CT of the toe would be overkill.

In other words, the type of studies and procedures performed on a trauma patient all depends on different factors. There's no one size fits all for every type of patient.

Bill Kirby · · San Francisco CA · Joined Jul 2012 · Points: 480

I've been to ER 1 or 2 times plus took a ride in a helicopter.

I'm not following why you're asking. I doubt for insurance reasons that you receive any tests that were unnecessary. Are you worried about paying deductibles for unnecessary tests?

Mike Mellenthin · · San Francisco, CA · Joined Nov 2014 · Points: 70

Not a climbing fall, but I was in a relatively bad bike accident involving a helmet cracked in half and a mangled shoulder. I wound up in the ER with a trauma activation

Didn't receive an MRI (can you even do that in the ER? I used to give people research MRIs for work and its pretty involved). They were very adamant about quickly checking for internal bleeding, but used ultrasound. I did get a head CT, but I was also super obviously concussed. As wing thing says above (edit: his answer is the best), you probably don't really want a full CT.

After they figured I wasn't secretly bleeding out I was left out in the hallway while gunshot victims and a dude who ODed and fell through a skylight were treated, which seemed completely reasonable.

JSH · · Unknown Hometown · Joined Apr 2007 · Points: 1,072

I think wingthing gave you your best answer. I have been helicoptered into ER after 40' groundfall. I got CTs only on specific body parts that were already identified as injured. I do not believe that I was MRId. Hope you are well.

Medic741 · · Des Moines, IA (WTF) · Joined Apr 2012 · Points: 265

Why are you asking?...

goingUp · · over here · Joined Apr 2013 · Points: 30

Given the significance of the mechanism of injury, you would get a CT every single time this happens. Due to the nature of the injury there is lot of potential of penumothorax, internal bleeding, vital organ lacerations, broken bones missed from distracting injuries, and its not uncommon for a patient to 'crump' from a missed internal bleed (most commonly into the abdomen), even when they present as 'stable'. The biggest reason is that a brain bleed cannot be assessed via Xray, and you need to know about these ASAP, not just after the patient goes unconscious or becomes altered. You would be surprised how many people hit their head and have a bleed but didnt think the head hit was as bad because of distracting injuries, like other broken bones (which are generally more painful)

MRI's happen, and can happen through the ER, but they take time and usually need time and a stable patient. They can be used to assess the seriousness of an injury or get a better look at soft tissue if things looked inconclusive on CT. Much less common, and not necessary to save lives - this is what x ray and Ct are for.

In short, a lot of ER care is based on protocol. Protocol is designed after lots of research into past incidences of related injuries. Given this mechanism of injury, a CT is standard operating procedure, MRI's possible and helpful but unlikely a mandatory study.

edit to add : wingthing nailed it...

Morgan Patterson · · CT · Joined Oct 2009 · Points: 8,794

Good luck and Heal fast!

Guideline #1: Don't be a jerk.

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