Question about C-spine immobalization.

[Para-Medic]

Hi,

Im trying to find if this could be a rule of thumb to determine if someone should get C-spine immobalization. Consider if someone's body was traveling at a rate in which the impact of a stop broke a limb or dislocated it, would you consider this as a rule to place someone in c-spine immobalization board? The acceleration could be caused my a fall, car, being thrown, etc.

[BlueLifeSaver]

I think every patient that has been involved in ANY trauma where c-spine injury can NOT be SPECIFICALLY ruled out, should be treated with full spinal immobilization precautions. Depending on the age and health of each patient, it may take more force in some patients to fracture a cervical vertebrae. If the trauma is unwitnessed, c-spine precautions should be taken regardless of the incident. These are just my opinions, but it's better safe than sorry. You can't HURT a patient by protecting their c-spine, but you CAN if you don't treat them based on a "broken branch" theory.

Stay Safe

[bandaidpatrol]

If in doubt, lay em out.

[JPINFV]

I think every patient that has been involved in ANY trauma where c-spine injury can NOT be SPECIFICALLY ruled out, should be treated with full spinal immobilization precautions. Depending on the age and health of each patient, it may take more force in some patients to fracture a cervical vertebrae. If the trauma is unwitnessed, c-spine precautions should be taken regardless of the incident. These are just my opinions, but it's better safe than sorry. You can't HURT a patient by protecting their c-spine, but you CAN if you don't treat them based on a "broken branch" theory.

Stay Safe

I will partially disagree. C-Spine is not a fully benign procedure. While, in general, the complications are not either seen or dealt with at the prehospital level, a patient should be monitored closely while on a long spine board.

[web:12cffaf812]http://emj.bmjjournals.com/cgi/reprint/18/1/51.pdf[/web:12cffaf812]

All traumas should be taken as a separate injury. A car accident with enough force to brake a limp should get a board and collar. The SNF patient that had an unwitnessed fall 4 hours ago, was up and walking around PTA and is A/Ox4, has PMSx4, no distracting injuries, and denies pain or tenderness of the posterior mid-line? No real need to. Different SNF patient with a mental disorder that fell the night before and has had a change in LOC from baseline per staff and is no longer ambulatory? Sure, board her up. As always, local protocols should be followed with a grain of salt.

[Para-Medic]

ok, here is a video that I saw that made me think about the question I asked:

http://video.google.com/videoplay?docid=-3868751167005642764

Now, you must be laughing because I know I was. It's not exactly visible but lets just say the kid broke his leg. It was a fall, it was a cushioned fall, but basically a sudden stopping force can be considered the MOI in any situation. Now, the kid didn't hit his head or land on his back or anything. But he still sustained an injury, now if the kid said he didn't have any back/neck pain would you still c-spine immobalize him? I say yes because the sudden stop could of jerked something out of place. But I know some would say no becuase the kid wouldn't be complaining of neck/back pain and because he didn't really land or hit his back or head. So what would you all say?

[JPINFV]

Sure, the patient would probably deny back/neck pain, but he also has a destracting injury. Of course, without actually examining the patient it is a null argument. Not boarding any trauma and boarding every trauma is not an answer. There has to be a happy medium someplace that takes into account both the mechanism and the presentation. Blindly following protocol can be just as dangerous as making stuff up on the spot.

[Eydawn]

Who puts this $h!t on the internet anyway? That poor kid... and who keeps $%&*( filming after the initial wups, got stuck in the hoop moment? That poor kid writhing around in pain is not F%&*() amusing at all. I can see watching the initial part... but jeebus. Makes me heartsick.

Wendy

NREMT-B

MI EMT-B

CO EMT-B

[Para-Medic]

Who puts this $h!t on the internet anyway? That poor kid... and who keeps $%&*( filming after the initial wups, got stuck in the hoop moment? That poor kid writhing around in pain is not F%&*() amusing at all. I can see watching the initial part... but jeebus. Makes me heartsick.

Wendy

NREMT-B

MI EMT-B

CO EMT-B

Oh come on wendy, not to be cruel but that kid knew what he was doing. He was planning that jump out and all. I just hope he learns not to make such idiotic decisions like that anymore.

[Para-Medic]

Sure, the patient would probably deny back/neck pain, but he also has a destracting injury. Of course, without actually examining the patient it is a null argument. Not boarding any trauma and boarding every trauma is not an answer. There has to be a happy medium someplace that takes into account both the mechanism and the presentation. Blindly following protocol can be just as dangerous as making stuff up on the spot.

Well, I think that C-spine immobalization protocols are just sometimes to general. The biggest indications of a needed CSI for me are poor sensation/motor skills, visible damage, obvious MOI that is known to cause C-spine damage, head/neck trauma, etc. For example, if someone falls off a small ladder and hits a rock that breaks their arm (lets say he fell from 4 ft high) we would splint their arm. Obviously, this would be done after the proper examination. Let's just say the examination revels this patient to not have any other complaints or obvious problems besides the broken arm. On the other hand, some people could say well maybe this guy didn't show signs of internal nerve damage but it would be on the safe side to board him. That arguments is hard to counter because you can't prove them wrong or right. So most people would just say just to be careful board them.

[EMS-Cat]

My rule of thumb is 'if you think it might be a concern [based on MOI, scene situation, gut feeling, etc] then collar them'.

What might happen if you do it and it turns out not needed? Probably not a lot.

What might happen if it was needed and you didn't do it? Could be a lot of bad for a long time for the poor guy.

I always lean toward the side of caution. I'd want someone to take that attitude with me and mine.