How to assess for fracture after a fall?

[HelloM1M1]

So my resident is totally confused, A&O x 1. She smiles all the time, so it's hard to detect any s&s of pain or discomfort. It's as if she could not register pain. She was admitted due to dx of T-12 fx. She's at risk for fall, and fell on my shift. Well I've only been on my own for a week, and I'm a fresh new grad. I was the only charge nurse there at the moment, and it was an un-witnessed fall. So I found her on the floor, in a sitting position, smiling at me. I asked if she's in pain, but she couldn't understand me due to her mental status and language barrier. She had a TLSO on. I looked at her head, her elbows, arms, feet, legs and didn't see any new skin conditions. The only thing that I didn't assess was her fracture because she had a TLSO on.

What I did was with the help of a CNA, I got her back up to bed. There was no complications noted. She was still smiling throughout the whole shift

Now that I'm looking back at this incident, I think I should've done the following: lower her down flat on the floor, log roll her to the side, take off TLSO to assess for fractures?

Any suggestions for this new nurse?

[CoffeeRTC, BSN, RN]

This is a tough one. I prob would have wanted to assess the back area while she was one the floor too. A fracture in the back/ spine wouldn't always show up just by looking at it. If it does, then that resident has a huge problem and would probably show pain.

I took an EMT course in college (got certified as an NREMT-B but never practiced....I kick myself for this now). One of the assessments I remember well and use for falls etc it DCAP-BTLS..deformities, contusions, abrasions, penitrations, burns, tendernes, lacerations and S? I may be off on some of them, but it guided you on what to look for in an incident situation. Of course, you add in other things like LOC, behaviors etc.

Assessing for a fracture you are going to look at the postioning of the resident, anything look deformed or any visible injury? What about ROM? Normal or painful? Think about how this happend (nice when they can tell you). Did they hit something when they fell or what body part did they fall on? focus on that area. After you do your nursing assessment you are going to report to the doc..sometimes I will suggest or ask for the Xray right then and there if I suspect a fracture or if I'm not sure, I will let the doc know about that too and leave it up to him or her. When in doubt, if something doesn't seem right, I'm going to err on the side of caution and let the doc know something doesn't seem right even if it looks okay.

[CapeCodMermaid, RN]

Demented or not, if someone has a new fracture, most likely they will grimace when you move them. Unless you have x-ray glasses, why remove the TLSO? If you are concerned she has a new fracture, call the doc and ask for an x-ray.