Contraindications to in-line spinal placement

[DwayneEMTP]

"A Second Officer brings c-spine into neutral in-line position (unless contra-indicated)"

I saw this quote on Timmy's vacuum mattress website and it got me to thinking.

In the basic academy we were told to return c-spine to neutral in-line position regardless of how it was found unless patient is screaming in pain (" and if it's really deformed they will be screaming!") or extreme resistance is encountered.

I also saw somewhere (maybe here, I'm not sure) someone talking of splinting the neck in the position found when it's extremely deformed, and getting reamed at the ER.

I believe the story went something like "positive PMS in all extremities, but neck deformed with head 90 degrees to shoulders". It's just hard to imagine forcing this injury back to it's inline position when this situation exists....(though I have a hard time imagining this situation existing)

What would happen in real life? Any stories, pro or con along these lines?

Thanks all...Have a great day!

Dwayne

[DwayneEMTP]

Yikes....days and no response...

Should I take the hint that this is really a dumb question?

Dwayne

[MeekoBB]

I don't know....For me, whenever possible we put inline...I have not yet come across a situation that there is a deformity or other.

Hell, I'm a friggin white cloud here....4 years and only 2 full working codes. :roll: May be rude to say, but people need to drop dead more so I can get more experience... I do tend to get a lot of CHF pts.

Cspines though....I've only gotten the standard neck/back pain where we board and collar based on the MOI.

[Ridryder 911]

I would do in-line alignment. it is not so much horizonal movement as flexon/extension of anterior/posterior movement.

R/r 911

[ncmedic309]

I would attempt to do inline stabilization. If you can't put the patient in an inline position, just immobilize them the best you can and document the situation.

[DwayneEMTP]

I would attempt to do inline stabilization. If you can't put the patient in an inline position, just immobilize them the best you can and document the situation.

But what would define "can't"? I'm thinking live deformations just don't happen that often?

Dwayne

[AZCEP]

A patient with scoliosis can't be immobilized the standard way.

If you meet resistance, or create pain, stop where you are and limit the motion from that point.

[ncmedic309]

But what would define "can't"? I'm thinking live deformations just don't happen that often?

I think your right, they don't happen that often. I've yet to see one in my career. I can't really say for sure until I'm in that situation and have to immobilize that patient. AZCEP brought up a good possibility, I'll add Kyphosis and Lordosis to that list, I'm sure they would make maintaining inline much more difficult..

[Doczilla]

Severe scoliosis or kyphosis from osteoporosis (what is this, Dr. Suess does ER?) may preclude putting the c-spine "in line", though you may be able to approximate its preinjury state. The attempt is not so much at "reduction" of a spinal problem but alignment with gentle traction. The need to manage the airway trumps leaving it in a severely deformed state, so there is no "contraindication" I am aware of that would lead you to leave it way out of place.

'zilla

[Timmy]

The only time I haven’t done manual realignment (Aussie version of in-line alignment) is on a young male who’s C4 was bulging out of his neck, he had no sensation what so ever any were in his body and couldn’t move. I left him there for the chopper medics to deal with!