The unusually warm fall weather brought a noticeable increase in people coming to the Emergency Department (ED) with injuries from doing outdoor activities. Paramedics called in to the ED with a report about a middle-aged female who had sustained injuries in a bicycle accident.
The paramedics said the patient was confused, didn’t know what had happened to her, and had abrasions to her face and right side of her body. Bystanders on the trail where she was biking had found her lying unresponsive in a ditch on the side of the trail and called 911.
We assembled our trauma team in the ED and prepared for the patient’s arrival in our trauma resuscitation room. When the paramedics brought Amy in on the gurney, she was holding her dented helmet in her lap. The paramedics had put a collar around her neck to protect her neck while transporting her. I put my hands around the collar to stabilize Amy’s neck as we carefully moved her from the gurney to the ED bed and began to evaluate her.
We methodically evaluated Amy from head to toe, first checking her airway, assessing her breathing, and checking her circulation. These are the ABC’s of emergency medicine, and we evaluate them in this order with every patient. As we move through A, B and C we make sure there are no issues with that respective assessment and treat any emergent problems before we move on to the next step.
Amy was able to speak and easily open her mouth with no signs of trauma to her mouth or teeth. I listened to her chest with my stethoscope to ensure she had equal breath sounds on both right and left sides. We also checked Amy’s pulses in her wrists and feet and noted that they were present and symmetrical. She was put on a cardiac monitor and had her vital signs obtained.
We then proceeded with a more detailed head-to-toe evaluation of Amy. She had abrasions to the right side of her forehead and her right cheek. Her pupils were equal and there were no other injuries to her head and face. She did complain of pain when I pressed on the bones at the back of her neck, so I resecured the cervical collar to protect her neck.
She had tenderness to the right of chest where she also had several abrasions, and she was tender in the right upper quadrant of her abdomen. She had abrasions to her right elbow and forearm as well as to her right hip, thigh, and knee. Amy had a lot of pain and swelling to her right wrist and complained of pain when she tried to move her hand.
Amy was able to follow all our commands when we asked her to do things as part of our assessment of her neurologic exam. When she first arrived, she was repeatedly asking what had happened because she couldn’t remember. We kept reassuring her that she was in the ED because she had been in a bicycle accident. Her mental status gradually improved, and while she still could not remember what had happened, she was aware of why she was in the ED.
We gave Amy pain medication and after getting several x-rays in our trauma room, she went to the radiology department for CT scans. Her imaging studies revealed numerous injuries: she broke her right wrist and several ribs on her right side. Her right lung did show some bruising where her ribs were broken but there was no further damage to her lungs. The scans of Amy’s head, abdomen, neck, and back were all ok, with no serious injuries found.
Amy’s wrist fracture was displaced and required the orthopedic surgeon to press on her fracture to improve the alignment of the broken bones before she had a splint placed on her wrist. As long her bones remained in the alignment they were in when the splint was placed, the orthopedic surgeon was hopeful Amy would not ultimately need surgery.
Amy was admitted to the hospital for close monitoring overnight. She was given an incentive spirometer, which is a small plastic device that helps to exercise your lungs. Using an incentive spirometer can decrease the risk of developing pneumonia by expanding the lungs, strengthening the lungs, and helping the patient to clear out mucous and secretions from the lungs. Amy required pain medications for her rib fractures and her wrist fracture.
She was seen in the hospital by a physical therapist, who helped her with her mobility with the limitations of not being able to use her right wrist. She also saw the occupational therapist, who evaluated her cognitive function due to her concussion. They recommended she avoid prolonged exposure to cellphone, television and other screens and in the following few days allow her brain to rest and recover from her injury.
By the following afternoon, Amy was able to walk around the unit without difficulty. She had been to the cafeteria with her husband and was able to eat and drink using her left hand. Her husband had gone to the trail to pick up her bike and he said that he thinks her crash was due to her brakes locking up. He had noticed a skid mark on the trail that led to where Amy and her bike were found on the side of the trail and her bike frame was not damaged. He was so grateful she was wearing her bike helmet, which likely prevented a more serious head injury.
Amy was discharged home from the hospital that evening and had an uneventful recovery. Her husband had already bought her a new bike helmet for when she was able to get back outside on her bike in the spring. She planned to spend the next few winter months doing her exercise at the indoor pool as she allowed her body to fully recover.
Dr. Erika Kube is an emergency physician who works for Mid-Ohio Emergency Services and OhioHealth.
This article originally appeared on The Columbus Dispatch: Dr. Kube: ED trauma team responds to bicyclist with broke wrist, ribs