Mechanism of Injury…
The mechanism of injury is an important part of history taking when finding out about an injured patient. You can tell a lot about the injury when you can visualise what actually happened.
If a patient states “I had a car crash”, the mechanism of injury allows us to find out speed, airbag activation, seat belt impact, position in vehicle, direction of impact et cetera, et cetera and take into account the clinical implications. Often it is fairly mundane stuff: “I slipped on the bottom step and my foot went inward” – OK so I know before I examine which ligaments are likely to be sore and which less so. But sometimes it can be a little more wacky!!
Here is my chance to vent some of my favourites…and yes groovers these are all straight from my patients mouth, please feel free to add your own…although there are plenty of urban legends out there (some involving being naked while using vacuum cleaners).
Busy Night shift in the Emergency Department…
A young lady presents with atypical lacerations to her back. She is embarrassed and not giving the doctors a good history. So I change my name to “Frank” and bluntly ask her what actually happened, because… “what your telling us doesn’t fit the injury”.
It turns out she and her boyfriend were in bed, they had a glass of wine which she’d place on the floor. They were (hmm… how shall I phrase this without getting an adult rating…ok…) pretending to be dogs, when he decided to step things up a notch(….hmm too cryptic), shove it in a different orifice (that should do!). She (understandably in my mind) objected and turned round sharply to get him off...(hmmm, that needs rephrasing too!!) tell him she wasn’t happy about his decision making.
Consequently she lost her balance and fell off the bed, landing on top of the wine glass, which obviously broke and subsequently caused the laceration. She ended up with several pricks in her back when we sutured her up, so a no win situation for her.
2 adult males presenting with rope burns to the neck. This story is summarised as it all got a bit “Jerry Springer”:
Basically to male friends had found out that one woman was seeing both of them…clear so far. They were upset, they had both been lied to, they decided to commit suicide together. (Nutty). They had one piece of rope and tied a noose in both ends, and climbed onto a big tree branch. The plan was they’d jump together (off opposite sides of the branch obviously) and hang together to teach her a lesson!!! (Don’t go out with nutters..perhaps?)
So there they are in the department with rope burns, but not broken necks…something else broke….that’s right….the branch snapped!
It all ended happily when the girl came to the department and she decided what to do. They left a threesome!!
As I right this I realise how absolutely absurd this sounds. I’m not sure I would believe me…but it’s true!
Kid with saucepan on his head…a stereotypical presentation. But I’ve only seen it once. Mechanism of Injury….Dad put it on his “Little solider!” Can’t even blame the kid!
So remember if you are going to do something stupid, and you might get injured, be prepared to share you idiocy with the emergency department staff, they won’t laugh…(in your face).