#178306 - 07/31/09 10:07 PM
Fractured Femur: Lessons learned
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Stranger
Registered: 07/31/09
Posts: 2
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First of all, I have lurked here for years. Since I didn’t feel I had anything to add, I never joined. However, primarily because of this forum, I ended up doing better at the scene of my accident than I had any right to expect. Here is what happened and what I learned from the experience.
FACTS:
Solo bike accident. I was in San Jose on a family outing. I was following my wife and adult step son. We went through a little “s” turn from one asphalt multi-use path to another asphalt multi-use path. Because I was the most experienced cyclist (and overconfident) I didn’t look ahead before entering the turn. As I entered the turn, I observed an orange warning cone in the middle of the path. I swerved to avoid the cone and dropped off the edge of the path onto the surrounding dirt. The bike slid out from underneath me and my right upper femur landed on the edge of the path. I did not hit my head and never lost consciousness.
I knew immediately it was a bad injury and directed my step son to call 911. When the first responders and paramedics arrived I advised them of the serious nature of the injury (I thought I had popped my hip capsule), directed them to take down notes on the various medications I had taken (all allergy based), advised them as to my allergic medical history, reminded myself repeatedly they needed to repeat the same questions many times to make sure they got the information correct and not to get angry with them. I made sure my wife had the contents of my jersey pockets (missed an allen wrench). I directed the first responders and my wife as to how best to physically support me.
After 10 mg of morphine the paramedics moved me to the ambulance. Once there, I quizzed the paramedic as to the various ER options and ruled out the first two immediately. (One was Kaiser and the other a small hospital). I ruled out Kaiser for 2 reasons-I wasn’t a Kaiser member and there was a possibility they would simply stabilize me and send me elsewhere. Since the hospital was small, I ruled it out. The remaining two options was the San Jose Trauma Center and 45 minutes further away was Stanford. I asked which one he and his fellow paramedics would go to and picked the Trauma Center. Once the choice was made, he called and obtained permission to administer another 5 mg of morphine.
Once at the ER they gave me another 5 mg of morphine. I directed them to cut off my shorts, explained my environmental allergy issue, asked for and obtained a prescription medication for allergies.
X-rays revealed a comminuted, displaced (2”) fracture of the femur in the trochanter area. This is immediately adjacent to the hip. I was transferred to a room while waiting for a surgical suite. Since surgery wasn’t immediately scheduled, I had my wife and step son research the assigned surgeon and do additional research on the hospital. Both got good grades and the surgeon had what I considered to be a good educational background. My step son found some negative comments about Stanford and I elected to stay where I was. Due to higher priority surgeries, I had to wait 27 hours before surgery.
Lessons learned:
Because I had visualized similar situations many times in the past and figured out what to do and the sequence of events, I never panicked, even though the pain was considerable and it seemed like forever before the first responders arrived. My calmness and take charge attitude helped those around me from escalating into panic or near panic mode. Because I hadn’t hit my head I was able to think fairly clearly and make the necessary decisions as to where to go and why. Since no one in my party had a GPS and we were unfamiliar with the area, there was a delay in the first responder’s arrival. In retrospect, a GPS would have speeded up things by 5-10 minutes. None of the traditional emergency/disaster items was of use in this matter, with the exception of cell phones.
Once I got to the hospital, I made numerous mistakes because I’d never thought through what was important. I didn’t ask for waterless shampoo or a shave. This would have been a good morale booster. I didn’t ask for a sponge bath. This would have prevented pressure sores from starting. I should have had some discussions with my wife as to what to do in case of something like this occurring, well before the accident. I didn’t do it because I “knew” I would never be the one to have a bad accident.
Since San Jose is about 300 miles from home, my wife was the one to drive us home. The trip lasted about 7 hours and the pain pills stopped being effective after about 5. I should have filled the pain medication in San Jose so I could have taken a second set of pills before getting home. When we did arrive in my home town, there was a delay in filling the prescription due to a clerical error causing additional delay. By then the pain was starting to get my attention.
Neighbors and friends were called for assistance once we got near home. I had 6 people help me get into the house, assisting my wife in setting up the spare bedroom for my use, unpacking the car and putting away the bicycles. Friends and neighbors have continued to be invaluable. They have installed entry ramps, replaced showerheads, installed grab bars in the shower, provided a commode adaptor to allow the use of grab rails in using the facilities and provided meals. In short, they have been fabulous.
I hope this report of my experience will be helpful to the community.
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#178308 - 07/31/09 10:33 PM
Re: Fractured Femur: Lessons learned
[Re: Oldmtngoat]
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Pooh-Bah
Registered: 12/18/08
Posts: 1534
Loc: Muskoka
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Welcome.
_________________________
May set off to explore without any sense of direction or how to return.
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#178317 - 08/01/09 12:07 AM
Re: Fractured Femur: Lessons learned
[Re: Oldmtngoat]
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INTERCEPTOR
Carpal Tunnel
Registered: 07/15/02
Posts: 3760
Loc: TX
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Welcome to the fire, new-goat! Sounds like it took a lot to get you here. Nice review, especially what you did wrong. There are lessons to be learned there (GPS, preparing wife, pain meds). Thanks for sharing. -Blast p.s. By chance do you ride with a quiet Chinese-ish fellow who busted up his femur a few years ago when he hit a railroad track on his bicycle?
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#178319 - 08/01/09 12:29 AM
Re: Fractured Femur: Lessons learned
[Re: Blast]
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Old Hand
Registered: 11/09/06
Posts: 870
Loc: wellington, fl
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Welcome aboard. Understand your rationale for hospital and doc selection, but it may have been self-defeating. Bigger hospitals get you bigger name docs, but more of your direct care will be managed by residents, interns, and breath-takingly over-burdened nurses: good place to be if you have an unusual diagnosis, not so good if you do not, since the facilities there are very busy, resulting in 27 hour waits for OR time. Fixing femurs is fairly straight-forward work, and you might have been served as well, and much more promptly, at the smaller facility. ER's generally will not stabilize and transfer a fractured femur-hard to effectively stabilize it. Should not have to ask for a bath, and really should not have pressure sores developing-both represent a failure to provide basic care. Consider raising the issue with the risk managers at the facility, in the interest of protecting future patients. Hope the rest of your recovery is uneventful.
_________________________
Dance like you have never been hurt, work like no one is watching,love like you don't need the money.
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#178329 - 08/01/09 02:00 AM
Re: Fractured Femur: Lessons learned
[Re: CANOEDOGS]
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Member
Registered: 02/24/07
Posts: 175
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not much in a pocket size kit would be much help unless its filled with pain meds and the PLB is beeping away..
Eureka! My new PSK: A PLB with 50 tablets of vicodin duct taped to it!
_________________________
When the SHTF, no one comes out of it smelling pretty.
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#178331 - 08/01/09 02:07 AM
Re: Fractured Femur: Lessons learned
[Re: Oldmtngoat]
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Member
Registered: 02/24/07
Posts: 175
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I didn’t ask for waterless shampoo or a shave. This would have been a good morale booster. I didn’t ask for a sponge bath. (snip!) Neighbors and friends were called for assistance once we got near home. I had 6 people help me get into the house, assisting my wife in setting up the spare bedroom for my use, unpacking the car and putting away the bicycles. Friends and neighbors have continued to be invaluable. They have installed entry ramps, replaced showerheads, installed grab bars in the shower, provided a commode adaptor to allow the use of grab rails in using the facilities and provided meals. In short, they have been fabulous.
I hope this report of my experience will be helpful to the community.
Welcome, old goat! I have waterless shampoo, shaving kit, and body wipes in our 96 hour kits, which are in our cars. It's amazing what just that will for to your morale, as you know.There have been several hospital visits that have gone MUCH better than it would have because of what we carry in our vehicles. Be sure to throw a thank-you party or something for your kind neighbors. I'm sure you'd be in the forefront helping them out in a similar situation. Again, welcome!
_________________________
When the SHTF, no one comes out of it smelling pretty.
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