I'm an MP (very similar to a nurse practitioner, just a slightly different scope of practice – main difference is that the government in my country was creating the role at the same time the USA was creating the role of nurse practitioner – now after globalization, we both are here)
I work in a rural night-only clinic that's around the capability of a stand-alone ED. We're associated with my countries national health authority, so we get referred patients from all sorts of places.
This occurred late on a week-night. Around 11pm. We got a heads-up call from the national health hotline about a patient that was referred to us. A highly intoxicated 15 y/o was being brought in by her parents after, apparently, falling.
Patient comes in, we had noone else at the time so we brought them straight back. They weren't clear on their issue beside they fell and arm was hurting, because they were agitated and screaming at us, occasionally vomiting from ETOH.
Refused to comply at all, but no allergies, denied medication, was aggressively requesting pain meds despite swinging at us & parents with the supposedly affected arm, denied history, etc. The shoulder area in general was swollen, but not impressively.
It was apparently too sensitive to palpate, and I was being threatened with various violent acts every time I tried – since pain is now the 5th vital sign and I wanted to see if I could feel anything before I unnecessarily irradiate a drunk 15 y/o, I gave some morphine. Still too sensitive. So let's nuke 'em
Ordered 2 view plain film scan of the clavicle / shoulder – was 100% expecting to see a perfect film. Yeah, that wasn't the case. A pretty high grade acromioclavicular injury, a clavicular shaft fracture, and a partial shoulder dislocation.
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