Differential Diagnosis: 62 year old Female – Fall
You are dispatched Code 2 (no lights and sirens) to a report an elderly female who fell on the steps of the library. It rained recently and has been cold out. There have been several slip-and-falls responded to around the city this morning.
As you pull up on scene, you find that your patient is still leaning up against the steps and has been covered with a blanket by a bystander. The patient tracks you visually when you walk up and appears to be in obvious pain. Witnesses report that the patient was walking down the ice-covered steps and fell. Both the patient and bystanders state that she did not have a loss of consciousness nor did she strike her head.
As you begin to assess the patient, she reports that she only has pain to her right knee. She denies feeling dizzy or weak before the fall. She has a history of hypertension and is currently taking Atenolol. She reports an allergy to aspirin. Enlisting the help of bystanders, you move the patient to the gurney and into the ambulance out of the cold. You now have an opportunity to directly visualize her knee:
There is obvious deformity to the knee joint and swelling to the back of the knee. The patient has good circulation, sensory and motor distal to the injury site. She is in significant pain.
What are your potential differential diagnoses? What is your treatment? What hospital services do you anticipate that she will need? Anything else?
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