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zeektheman

3 ft fall spinal immobolization

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I wouldn't have immobilized, though with a head lac, I would have been prepared for blowback from the ER. Not from the docs most likely, but from some nurses.

It can be complicated sometimes trying to do what's right for the patient, satisfying your protocols, and trying to keep a good relationship with the ER so that you can get the orders you'd like, when you'd like them.

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Fall + Head injury are enough for me to take precaution. The word says it all, it's "precaution", when I don't know for sure I'd rather do a bit more than a bit less. Plus, when arriving in the ER I'm sure to get the nurse's attention faster.

In this case I would have used a collar + vacuum mattress.

These precautions are also taken because we carry our pt, and drive around. In case of fall or crash, this additional protection wouldn't be too much.

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In this case I would not have boarded and collared. I would though have done a very good exam both verbal and physical. All of my findings would have been documented.

I had a pt on New Years day who was fighting around with his brother and fell on cement. Of course both were pissy eyed drunk. Any ways I did not collar or board because he was resisting everything I did and flailing his head around. If I did I thought he would have done more damage if there was any. Went to the hospital and explained to the receiving nurse my thought process, he agreed but put on a collar anyway to cover his ass.

As I am getting older I do go more by my gut feeling in few areas and I have also discovered that in my community I try to work with the hospital staff and have discussions on why or why not I do things. I have noticed that by doing this I have more respect for the nurses, and drs and they also have more for me. If you have a nurse question you on your treatment be professional and explain, you might be surprised at the response you receive.

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My EMT book said that an significant MOI for an adult pt was a fall of 20 or more feet, but it seems like a fall of any height would be significant.Can someone clarify?

Edited by Caduceus

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Current literature refers to fall from standing height or greater in most cases. Every pt will be different in what constitutes a serious fall.

I've fallen from 12 feet off roof edge and had nothing more than a sore butt .

For a little old lady with osteoporosis a fall from standing height has a much greater probability of serious injury to legs, hip dislocation , pelvic fracture or compression fractures to the spinal column.

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I had a patient fall from a standing height fracture both of her femurs, both tib/fib and a pelvic rim fracture.

Current literature refers to fall from standing height or greater in most cases. Every pt will be different in what constitutes a serious fall.

I've fallen from 12 feet off roof edge and had nothing more than a sore butt .

For a little old lady with osteoporosis a fall from standing height has a much greater probability of serious injury to legs, hip dislocation , pelvic fracture or compression fractures to the spinal column.

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I had a patient fall from a standing height fracture both of her femurs, both tib/fib and a pelvic rim fracture.

Me too, and I've had a baby fall from the ground floor to the basement concrete and suffer only a bruised butt and back. We transported the baby to the peds trauma center and he went home 4 hours later.

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In some traumatic contexts babies and small children can suffer less damages than heavier, rigid-boned adults.

But there is something I don't get. I've never had any trouble with any pt about immobilization. Some have found the backboard to be unpleasant to stay on, but I've never had any complain about the vacuum mattress. That is for the patients without any mental alteration.

I've always worked looking for the reason to immobilize rather than the reasons not to. When the decision isn't so clear, I'd rather take precautions and put someone who's okay in a mattress, rather than deal with someone who suddenly feels a back pain while seated during transport, because he ambulance shook him/her a little.

Or am I missing something?

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Current literature refers to fall from standing height or greater in most cases. Every pt will be different in what constitutes a serious fall.

I've fallen from 12 feet off roof edge and had nothing more than a sore butt .

For a little old lady with osteoporosis a fall from standing height has a much greater probability of serious injury to legs, hip dislocation , pelvic fracture or compression fractures to the spinal column.

Okay. Thanks for the clarifiction. Kinda sucks the book wouldn't say that considering it was published late 2013 :P

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I would have used spinal precautions with this patient and here is why. While the patient only fell 3 feet, there was trauma noted to one arm and also to his head. Since we can not see inside of his head & cervical spine then it is best to take precautions. I had a fellow Paramedic who cleared a guy who had a small branch hit him on the head while trimming trees in his yard. The guy looked fine except for a small laceration on top of his head. The Paramedic opted not to take spinal precautions, but when they arrived at the ED a CT was ordered and it revealed a sublaxation of his cervical vertebrae.

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