C-Spine versus lower spine immobilization

[emt322632]

I'll go with all or nothing. Depends on the pt. and MOI though.

[Dustdevil]

Consider the spinal column to be similar to any other long bone with a joint at both ends. If you immobilize the center of the bone, but don't secure the two ends movement at either one will reduce the effectiveness in the center.

Great analogy. This would be like immobilising a tib-fib without immobilising the knee and ankle too. It cannot be done effectively.

[Doczilla]

Direct trauma to the lower back, such as from a direct blow with a baseball bat, is highly unlikely to cause c-spine injury. Global deceleration trauma, such as in an MVC, which causes a t-spine fx has a high rate of associated C-spine and L-spine fx (I forget the exact number, but it's double digit percentage). Therefore findings of thoracic or lumbar pain in a fall or MVC or something along those lines should prompt c-spine immobilization.

Think of the t-spine as a "cage". From a structural standpoint, it's very strong, forming a complete circle with the ribs and supporting intercostal structures. This would therefore be the "strong" point in the spinal chain. The low cervical levels and high lumbar levels, being relatively weaker with less supporting structure (though the lumbar vertebrae are thicker and by themselves stronger than thoracic vertebrae), are the points where we are likely to see fractures, since this is the closest point to the thoracic vertebrae where force can be dissipated (and released, through fracture).

Note also that severe pain, such as from a back fx, would be considered a distracting injury, and you would not be able to exclude them from c-spine immobilization if mechanism suggested the possibility of it.

'zilla

[AnthonyM83]

Note also that severe pain, such as from a back fx, would be considered a distracting injury, and you would not be able to exclude them from c-spine immobilization if mechanism suggested the possibility of it.

And what if the injury was localized and NOT global deceleration, rather localized direct blunt trauma, such as baseball bat for side of 4x4?

[Dustdevil]

And what if the injury was localized and NOT global deceleration, rather localized direct blunt trauma, such as baseball bat for side of 4x4?

That's where it gets kind of sticky. Nobody xeems to be able to qualify or quantify what is a "distracting injury" for the purpose of the protocols. Everybody seems to have a different idea of how this should be defined. That's what I see as one of the weaker points of SSI. It remains too abstract to be implemented in a paint-by-numbers fashion, which is what most idiots in EMS want. Of course, it's not just what they want. It is what they need.

[firedoc5]

Direct trauma to the lower back, such as from a direct blow with a baseball bat, is highly unlikely to cause c-spine injury. Global deceleration trauma, such as in an MVC, which causes a t-spine fx has a high rate of associated C-spine and L-spine fx (I forget the exact number, but it's double digit percentage). Therefore findings of thoracic or lumbar pain in a fall or MVC or something along those lines should prompt c-spine immobilization.

'zilla

On a few occasions I've noted where some that were hit in the mid-lower lumbar region, bat, crowbar, etc. that the force buckled or "whipped back" the upper spine hard enough to cause a whip-lash injury. One guy I knew, Rex, in particularly. So it's not unheard of. I'd rather be on the side of caution anytime there is any kind of possible spinal injury.

Not meaning to cause any kind of debate, but...