A previously well 80-year-old experienced a fall at his home where he lives alone. He was walking from the living room to the kitchen when suddenly he found himself on the ground, which he attributes to tripping on the runner rug in the hallway.
“My son has been telling me to get rid of that thing for years but I don’t like getting the carpet dirty.”
Unfortunately he injured his hip in the process and wasn’t able to get to the phone to call for assistance, spending two days on the floor until the Meals on Wheels volunteer came by. Skin is cool and dry and his mucous membranes are dry. He has severe pain and external rotation of his left hip. You cannot assess shortening because the knee and hip are both flexed, in a position of relative comfort.
Vitals upon your arrival are:
- Heart rate: 45-65 bpm, irregular
- Respiratory rate: 14 /min
- SpO2, room air: 97%
- NIBP: 179/93 mmHg
- Temp, oral: 36.3 C (97.3 F)
While you are drawing up an initial dose of morphine your partner captures the following 12-lead.
What does it show? How will this affect your management?