C-Spine For Penetrating Injuries

[AnthonyM83]

Are x-ray machines now on the ambulance? How do you know where the bullet stopped, where is it resting, has it fragmented (with or without an exit wound), spinal immobilization serves more purposes then to protect the spine, it keeps the body stable, takes 1 minute (add a minute if your patient is moving) to get the patient on the board and ready to move, no big deal.

Not with our c-spine. The process of setting up the backboard so straps don't get under board, our less than adequate belt system, grabbing at all the straps, sticking this head wedge thing onto board, and sticking the tape, with one person (if partner is holding c-spine) or even with many takes longer (if you're doing good cspine)...at least for us.

If patient is altered and grabbing blindly at you (and your face/mouth/eyes/clothes/equipment/straps) with bloody hand, it takes longer than 2.

[WANTYNU]

What do you guys say about blunt trauma to lower back? How do you immobilize? Not talking baseball bat stuff...just stuff where no cervical pain/deformity etc etc, except for lower back.

It seems pretty much anything that has MOI (bat to back would count) or is suspect of internal trauma gets a LB, but thats NYC, I sure someone here could give a better answer.

Be Safe,

WANTYNU

[AnthonyM83]

It seems pretty much anything that has MOI (bat to back would count) or is suspect of internal trauma gets a LB, but thats NYC, I sure someone here could give a better answer.

It seems like anything you would start the pain/deformity/neuro/LOC algorithm for would qualify...because they're technically stopping you there.

[WANTYNU]

Not with our c-spine. The process of setting up the backboard so straps don't get under board, our less than adequate belt system, grabbing at all the straps, sticking this head wedge thing onto board, and sticking the tape, with one person (if partner is holding c-spine) or even with many takes longer (if you're doing good cspine)...at least for us.

If patient is altered and grabbing blindly at you (and your face/mouth/eyes/clothes/equipment/straps) with bloody hand, it takes longer than 2.

I've been to the shows and seen the new LB, they are better, (I don't think our's have changed in 20 years), but the new ones do take longer to set up, even so, in my book its time worth spending if it prevents further injury.

remember the golden rule: "Do No Harm"

-w

[WANTYNU]

Well it has been scientifically confirmed that stab wounds , penetrating trauma is bad.

I hope this video helps.

http://www.joecartoon.com/videos/556-multiple_stab_wounds

Be Safe

WANTYNU

[ERDoc]

OK, given those 2 scenarios given by stcommodore:

Case 1: Theoretically should be fully immobilized. They have an AMS which makes you unable to assess for neuro deficits. Though, nothing will probably save this guy, the discussion is purely academic. However, scene is unsafe. As far as I am concerned scoop and run. Sorry dude, my life over yours (at least if you have any left).

Case 2: Does not need a cervical collar. He is neurologically intact. No one is making jusdgements about a long board to keep the rest of the spine secure. There seems to be some confusion about what immobilization means. The c-collar only immobilizes the cervical spine. If you have a localized injury to the thoracic cord, a c-collar will do nothing to protect it.

Reread what the PHTLS book says:

In general, if a patient did not sustain definite neurologic injury at the moment that the trauma occurred, there is little concern for a spinal injury. This is because of the mechanism of injury and the kinematics associated with the force involved. Penetrating objects generally do not produce unstable spinal fractures as does blunt force injury because penetrating trauma produces little risk of unstable ligamentous or bony injury.

Penetrating injuries do not cause unstable spinal fractures. Therefore there is no potential for cord damage following the injury due to the patient moving. Any cord damage is going to happen at the time of the injury and will manifest immediately. Interested in a little EBM, here is an article to review:

http://www.ncbi.nlm.nih.gov/sites/entrez?D...Pubmed_RVDocSum

There were 57,532 patients that were evaluated at the two trauma centers. Of those, 42.3% (24,336) were following blunt or penetrating assault. All of the penetrating injury patients with a cspine fracture or cervial spinal cord injury had some form of neurologic deficit on presentation. There was one blunt assault patient who presented without neuro deficit, but he had neck pain at the time of presentation. All patients with cervical spinal cord injury had a neuro deficit on presentation.

Here is one more for you:

http://www.ncbi.nlm.nih.gov/sites/entrez?D..._RVAbstractPlus

Here is one that discusses putting the pt on a board:

http://www.ncbi.nlm.nih.gov/sites/entrez?D..._RVAbstractPlus

Here is one that I found interesting, though I'm not too sure how I feel about it yet:

http://www.ncbi.nlm.nih.gov/sites/entrez?D..._RVAbstractPlus

[stcommodore]

Our protocol (a guideline...well technically) for EMT-B is ONLY based on MOI . . . For paramedics it seems to be what PHTLS says. So, if EMT's aren't supposed to take into account pain, deformity, neuro deficit, then almost anything would require immobilization... http://ladhs.org/ems/Manuals/Medprotocols/...obilization.pdf

PHTLS is for EMT-B's to. If we don't trust what the studies tell us then how do we expect to be considerd anything but tech's? We have so very little EMS research as it is that when something like this presents itself do we consider it or brush it off in favor of 'what we have always done.'

[AnthonyM83]

It's Los Angeles, it's hard to be more than simple technicians with the protocols.

[A2E]

Here is one that I found interesting, though I'm not too sure how I feel about it yet:

http://www.ncbi.nlm.nih.gov/sites/entrez?D..._RVAbstractPlus

"RESULTS: There was less neurologic disability in the unimmobilized Malaysian patients"

I once saw a study claiming that ICU patients who received more units of blood had higher mortality rates, and therefor concluded that you should avoid giving blood. However, it stands to reason that if a patient were receiving multiple units, his underlying disease was probably more severe to begin with, hence the higher mortality...

Same here: I don't have access to the full article, but I would imagine that patients who were backboard-stabilized probably had more severe injuries (or at least mechanisms of injuries) than those who weren't. I also have no idea where the two university centers mentioned are in relation to each other, but perhaps patients with more severe injuries are transfered to the New Mexico one? Or perhaps the other one is in a setting with less likelihood of high-speed collisions, etc.

In short, it seems like their study group and control group could, potentially, be very different from one another.

[CBEMT]

Not with our c-spine. The process of setting up the backboard so straps don't get under board, our less than adequate belt system, grabbing at all the straps, sticking this head wedge thing onto board, and sticking the tape, with one person (if partner is holding c-spine) or even with many takes longer (if you're doing good cspine)...at least for us.

So don't pre-set the straps. That's why the pins are there in the first place, if you use quick-clips- to make it easier to strap the patient in once they're already on the board. You can't set straps for a patient that you don't know how much space they're going to take up anyway.