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 Case
#29 He’s Not Moving!
EMS calls in a 14 y/o football player,
injured on the field. They note he is
paralyzed from the neck down, confused, with
vital signs: 110/70, HR=110, RR=20. ETA is
10 minutes.
On arrival, EMS report that the freshman
football player was unconscious after a
tackle, and after about 1-2 minutes, the
patient woke up, but was confused. He was
initially unable to grasp with his hands or
move his legs, but after EMS arrived, he
could move his right big toe, and left
little toe (still no grasp). He did complain
of neck pain. He was also incontinent of
urine.
According to his mother, he had a normal
delivery, but stayed six weeks in the ICU
from sepsis. He required a chest tube, and
was ventilated for a few weeks. Since then,
he has had no significant medical problems,
no previous injuries and no surgeries.
VS: 115/70, RR=20, HR=100
PE: WDWN male, helmet on, still in uniform,
neck immobilized with foam and strapped to
the back board. He is breathing
spontaneously, and verbally responsive.
PERRL
Heart RRR,
Lungs clear, good respiratory excursion.
Equal breath sounds
Abd soft, scaphoid, non-tender, + bowel
sounds
Ext, still in uniform, but no obvious
lesions to lower leg or upper arms.
Neuro:
Mental Status: He is slow to answer
questions, but is oriented (person, place,
date). He is amnestic for the event, and
condition on the field before arrival in the
ED. (He does not recall the paralysis.)
Cranial nerves in tact.
Motor exam: 4/5 grasp strength, able to hold
arms at 45 degrees, but drifts at 10
seconds. Legs, able to hold at 30 degrees,
but drifts some at 5 seconds.
Reflex: +2 patella, biceps, and
brachioradialis. Babinski normal.
Sensorary: Normal throughout
Cerebellar: Finger to nose normal, heel on
shin normal.
1. How do you remove the helmet and get
him undressed and in a cervical collar?
2. His mom is relieved he no longer is
paralyzed, but wants to know what happened,
and if he will be OK.
3. What do you order?
4. Should he quit football?
Click here for answers and to respond
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