Emergency Room Secrets: Falls, Fractures, and “FDGB”

Our physician contributor lets you in on some emergency room secrets, among them the type of codes that help save precious time. For example, there’s FDGB….

Dr. Jim Bregman, MD

James M. Bregman MD is an Emergency Physician at White Plains Hospital in New York. He has been on staff there since 1993 after completing his residency at Montefiore Medical Center, N.Y. He's also an adjunct professor at Pace University’s Physician Assistant Program.

“FDGB” is a common occurrence in the Emergency Department setting. The first question is: How common and varied is FGDB? The second question is: Exactly what is FDGB? Our emergency room secrets include the story behind that code.

You see, in medicine we use mnemonics, abbreviations, and medical slang like they’re going out of style. I’m setting out to introduce you to the practice, one that takes in emergency rooms throughout the country each day. My diagnosis of the use of “codes” in ER settings: It’s extremely varied in severity, presentation, and anatomical involvement, but it employs a vast wealth of medical resources.

Let me illustrate the medical condition FDGB by reenacting an ambulance call received in my department on a regular basis:

“Dr. Bregman… there is an ambulance call… please pick up….”

“Hello, EMS Doc Bregman here… what have you got?”

“Hey doc… coming in with an 82-year-old female FDGB with right hip pain. Has stable vital signs, and we’re are starting a line and want to give her some morphine…. She may have a hip fracture.”

“Okay, we receive you and will be expecting you…. I’ll tell the charge nurse…. What is your expected ETA?”

And there you have it—another patient on the way to the ER after falling down and injuring herself. Oh yeah—that FDGB code: “fall down go boom.”

“FDGB” in no way is meant to be callous or cold; it’s just our lingua franca in the emergency setting. We talk over staticky short-wave and police radios, and we work in an environment that’s at a constant low-level din at best. As a result, we have developed a type of communication that allows us to compress information into short bursts. It’s not quite like the Navajo code talkers of World War II, but it’s close.

Emergency-Room Secrets: How Codes Can Help

emergency room secrets

Our physician contributor reveals an emergency room secret: “FDGB” is a code for a certain type of injury. It “in no way is meant to be callous or cold”—rather, it helps personnel react quickly and efficiently.

The considerations when receiving an FDGB are vast. A person falling off a curb or stumbling over his poodle in the house is very different then a fall off scaffolding or down the stairs.

The variation in severity of injury is apparent when considering all the different types of falls and the medical needs and approach to such a patient. A simple fall with an outstretched hand to protect oneself can result in a wrist fracture or sprain. These isolated injuries often result in a cast or splint, and can even require a surgical procedure for correct healing and function.

Conversely, a complex fall, for example, down the stairs or from a substantial height can cause multiple injuries at different anatomical sites. We call this a “multi-trauma.” There can often be a related head injury (closed or open) and/or extremity trauma and injury to the trunk, abdomen, or back. For instance, a fall down the stairs can cause rib fractures if one is sliding down the stairs on their upper side or back, and can also result in ankle injury, or more, if an extremity is caught on the way down.

In the example of the “stair tumble,” we can imagine how a person may suffer an impact to their head on a step, wall, or railing on the way down. He or she may suffer a concussion or even worse—and a loss of consciousness can be part of the relevant history.

In severe head injuries patients can have hematoma, or collections of blood that can accumulate on the outside or within the brain tissue. These hematomas (depending on the type and severity) sometimes need drainage by surgery or decompression to prevent brain injury. The various types of brain injuries are so vast that they merit a discussion I’ll save for another day. But suffice to say that these types of injuries may alter the level of consciousness of a particular patient and cause varied degrees of disorientation and even memory loss.

Falls and Fractures

When considering FDGB cases, hip fractures are probably the most common type of severe fall seen in a community hospital Emergency Department. The reason for this is obvious, if we consider the demographics of those who fall and their susceptibility to injury. It just so happens that 90 percent of all hip fractures occur in patients over 75 years of age. The elderly are not only the most likely to fall, but are also the most likely to sustain severe bone injury after an FDGB.

Unsteady gait, muscle weakness, dizziness, vertigo, Parkinson’s disease, poor eyesight, prior strokes, arthritic diseases, medications, and heart disease are all factors that increase one’s risk of falling. And those ailments often accompany osteoporosis, osteopenia, malignancies, arthritis, and the aging process in general, resulting in the weaker, less dense bone structure of this population.

Services That Help Prevent Injuries: Are They Endangered?

Considering the combination of an increased mechanism for FDGB and a greater susceptibility to fracture, it’s no wonder that hip fractures are the most common serious fall injury occurring in our community.

emergency room secrets

Programs that help seniors—who are most susceptible to falls—are important in preventing injuries.

For this very reason, resources that help the elderly, stabilize them, and improve eyesight and stability can positively impact our finite medical resources and save millions of dollars annually. Home visits by professional nurses and aides, physical therapy and devices (such as walkers and canes) designed to help the elderly ambulate safely will surely reduce falling along with many of the resultant medical complications that arise from FDGB visits to hospitals.

Such services as “meals on wheels,” senior centers, ambulette services, homecare services, and senior exercise programs have been shown to strongly impact the activity and vitality of the elderly and improve overall health, reduce falls, and save the healthcare system millions of dollars.



For more from Dr. James Bregman, see these University Health News posts:

Quick fixes or proposed budget cuts that reduce such services often save us nothing in the long run, and are certainly not measures that improve our citizens’ lives and well-being.

Be very wary of a people who say they know how to “fix everything.” Be very skeptical of those who claim they can figure out this system in a few days or few weeks. They likely know not what they are talking about. These problems are often complex and subtle, and require some thought, insight, and analysis. I’ll say it again for those who think they know how to fix our health system: “Thought, insight, analysis”

When it comes to falls (or FDGB), the topic is vast and the problems are varied, but I believe we can all relate to the surprise, anxiety, and fear that comes with them.

Who has not stepped on a magazine, slipped on ice, stepped off an unseen curb, caught a shoe on a door jam, tripped over a low piece of furniture, worn slick slippers on the wooden stairs, or tripped over the cat? If you haven’t, you’re fortunate, but if it happens, we in the ER are here for you.

This article was originally published in 2018. It is regularly updated. 

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James Bregman, MD

James M. Bregman, MD, is an Emergency Physician at White Plains Hospital in New York. He has been on staff there since 1993 after completing his residency at Montefiore Medical … Read More

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