Reflection_on_Ankle_Injury

Description My colleague and I were called to a 35 year old male at a petrol station who had fallen and was reported to have sustained some kind of leg injury by the caller. As we travelled to the location I was thinking about what severity this leg injury may be as the details given were limited. I was making a mental plan of action for all the possible types of leg injury I could think of, from a minor abrasion to a severe penetrating injury. On arrival at the petrol station we were directed into a room by the cashier’s desk to find the patient sat with his right foot resting on another chair. He was conscious and breathing but clearly experiencing some degree of pain. I began to gain a comprehensive history from the patient to establish the mechanism of injury. He informed me that he had just got out of his car to refuel when he slipped on a patch of spilled petrol and in the process of trying to regain his balance his ankle twisted under him. Feelings Initially, I felt that the man’s injury did not warrant the use of an emergency ambulance and a taxi would have been more appropriate but as the story unfolded, it transpired that the staff at the petrol station had seen the man fall and called for us before assessing his injury. After this information was divulged I was glad that I had given the man the benefit of the doubt before expressing an air of dissatisfaction at being called to this job. I was also mindful of my duty to act in a professional and courteous manner toward patients at all times (HPC code of conduct). Evaluation This incident was easy to deal with as the man’s injury was not life threatening and relatively easy to manage. He was apologetic that an ambulance had been called and said he was somewhat embarrassed. I reassured the man that he had done nothing wrong and we struck up a good friendly rapport. I believe my assessment and treatment of his injury was accurate and performed to a high standard. The petrol station staff however, were quite rude and obstructive when they found out that we were taking the man to hospital and leaving his car on their property. This perplexed both my patient and ourselves as it was the garage staff that were in haste to call us in the first instance. Analysis I assessed this patient using the ABCDE method of approach (European Resuscitation Council) , Pain score ladder, visual and palpation examination taking into account ranges of movement, presence of distal pulses, any obvious neurological deficit and crepitus, obvious deformity and ability to weight bear. I was confident that the patient had not sustained a fracture but due to his discomfort we transported him to the ambulance on the stretcher. The patient had a pain score of 4 which was reduced to 2 with administration of Entonox. I made the decision to take the man to the hospital A&E as he has some swelling to the lateral aspect of his right ankle and could not put weight on it therefore I could not rule out a fracture completely. He would therefore require an X-ray for definitive diagnosis. We transported him to hospital without the use of visual and audible warnings as his condition did not warrant blue light transport. (Emergency Vehicle Driving guidelines 2006). Conclusion I believe that my treatment of this patient was correct and comprehensive. I don’t think that there was any further treatment I could have carried out that would have benefited his recovery or subsequent treatment. I don’t think I could have referred him to another unit such as the walk-in-centre as he would still be required to go to the hospital for an X-ray. Action Plan If I were to deal with this type of injury again I would apply the knowledge I have gained from personal study regarding the examination of an ankle/foot injury and the Ottawa rules in order to assess the patient’s suitability for referral to A&E for X-ray. In this instance the patient would still have been referred to the same department due to the nature of his injury.