Emergency Dept Case Studies
Hip Fx
Mr. F is an 82 yo male from the Coolidge House who presents to the Emergency
Department s/p fall. Staff of the nursing home notified the EMT’s that the patient has not
been able to ambulate since the fall 2 hours ago. The EMT noted the left leg to be
shortened and externally rotated. Patient is alert and oriented x3.
What other information do you need concerning the fall?
How did the patient fall- trip and fall or other precipitating factors such as
chest pain, dizziness? Patient may need work-up for MI or syncope.
The patient has full recall of events and states that he tripped over the rug.
Mr. F states he did hit his head but did not lose consciousness. His VS are
190/100, 92, 28. What important information would you need at this time?
Why is early measurement of VS particularly important in patients with
known or suspected injuries of the pelvis?
Is the patient on coumadin or other anticoagulation medication? Is a head CT necessary
in this case? (unless patient had LOC or is on anticoagulants head CT probably not
necessary).
Early VS in these patients is necessary because they could have a bleed into the pelvis and
become hypotensive.
After obtaining the above information, what interventions or diagnostic procedures
should be initiated?
Full medical workup can be initiated if highly suspect hip fracture. This includes EKG,
#18 angio, and pre-op labs (including- cbc, sma-7, pt/ptt, type and screen). Place a
foley- send ua to lab.
Foley is necessary for a couple of reasons:

May be too painful for patient to get on/off bedpan

Determine if any damage to the GU tract or obstruction from swelling.
Also may order hip/pelvic films
Anticipate chest x-ray- if + hip fracture pt will need pre-op chest film