Contraindications to in-line spinal placement

[Dustdevil]

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.

That pretty well says it all. As for the frequency of finding a traumatically angulated c-spine, it's pretty darn rare. And one that cannot be re-aligned is usually on a dead body anyhow. Live people's necks remain supple for the immediate aftermath of most injuries. I've just never encountered this problem in a living patient, except for those described by Zilla. Old, contractured, arthritic geriatrics may have a permanent crick in the neck, but they also don't get into many wrecks, so I have never encountered one in the field.

[DwayneEMTP]

Thanks all!

Your answers are what logic was telling me was right,(except for scoliosis or kyphosis from osteoporosis) yet it seems the more I learn the less common logic seems to apply.

The more I learn, it feels like the less I know...if I learn much more I won't know anything!

I had to ask though as I've heard some pretty amazing stories....which I think I'll move into the B.S. column until further notice...

Thanks again....Have a great day!

Dwayne

[Shelbmedic]

I have had one call about 5 years ago. We were at the local hospital when a young kid approx. 10yrs old walked into the ER with his father his neck was deformed just looking at him you could tell what happened. Father stated son fell in the tub the night before struck his head/neck in the tub went to bed that night and woke up this am with his head turned hard to the right with his chin touching his Rt shoulder. the RN at the hospital was there we offered to take control of c-spine but she refused our help. The RN had the pt walk to ER room and sit there in a chair and wait for the Dr. We bought our concerns to her about c-spine but she said you were not called for this don't worry about besides he fell last night and has been up walking around he is fine. So the Dr. comes in feels the pt neck says you will be fine here is some TES you'll feel better in a couple of hours.

So I said to the Dr. your not going to x-ray the kids neck nope he fine.

So we ran out to the kids parents and told them how we felt and that if this was my kid I would demand c-spine and x-ray. parents said the Dr. knows best and they said that the Dr. wouldn't be wrong. We gave our advise if any thing changed to call 911 and we would treat him and by pass this hospital and take him to a hospital with CT.

2 hrs later toned out for the kid his neck got worse we c-spine him in position found he couldn't turn his neck when he tried he became weak in the arms and his chest felt heavy. So we called life flight in the kid was taken to Childerns Hospital had # c-3,c-4.

[CAPMEDIC-EMWFR]

I have had one call about 5 years ago. We were at the local hospital when a young kid approx. 10yrs old walked into the ER with his father his neck was deformed just looking at him you could tell what happened. Father stated son fell in the tub the night before struck his head/neck in the tub went to bed that night and woke up this am with his head turned hard to the right with his chin touching his Rt shoulder. the RN at the hospital was there we offered to take control of c-spine but she refused our help. The RN had the pt walk to ER room and sit there in a chair and wait for the Dr. We bought our concerns to her about c-spine but she said you were not called for this don't worry about besides he fell last night and has been up walking around he is fine. So the Dr. comes in feels the pt neck says you will be fine here is some TES you'll feel better in a couple of hours.

So I said to the Dr. your not going to x-ray the kids neck nope he fine.

So we ran out to the kids parents and told them how we felt and that if this was my kid I would demand c-spine and x-ray. parents said the Dr. knows best and they said that the Dr. wouldn't be wrong. We gave our advise if any thing changed to call 911 and we would treat him and by pass this hospital and take him to a hospital with CT.

2 hrs later toned out for the kid his neck got worse we c-spine him in position found he couldn't turn his neck when he tried he became weak in the arms and his chest felt heavy. So we called life flight in the kid was taken to Childerns Hospital had # c-3,c-4

Uhm, I may just be a student, but the above story kind of smells like bullshit to me. The majority of the Docs I know would never even consider not x-raying the c-spine with an obvious deformity like the one mentioned, or at least holding for observation. Talk about major liability. I think it is amazing how you were the only ones to see some sort of abnormality with that patient. What hospital did he go to, if the staff is that incompetent, I don't want to be anywhere near it!

[Shelbmedic]

Well I live in a small Town in Canada where The local Hospital Dr.'s are still like Gods to the local people. I have been doing this job 18 +++ years. I have seen plenty of things happen in this small hospital that have been written up by me but goes now where since the family of the Pt had told the Dr. of the children Hospital that they couldn't understand how the medics were so concerned about our child when the Dr. and nurse blew his neck being stuck off to a " Sprained Neck" as indicated in the OPD Dr. report. Trust me this one went to court down the road the Dr. was only caught on this case because the Dr. at the childerns hospital made the family aware that there was no way that the pt neck should not been x-rayed.

Final out come the kid made a recovery and is doing fine his family has moved but they still keep in contact with me.

This was not the first time this particular Dr. to SCREW UP! and not x-ray people. But in this town when you bring it to the people attention they say "no way he's a Dr. he can't be wrong"

I don't care if you if you think it's bull shit. Unless you have lived in that town you'll never understand.

In Canada alot people don't think Dr. can be wrong especially in the rural areas.

[zippyRN]

sounds like an error of history taking

there was head / neck trauma in the history for that young man

rather than the typical pattern of people who wake up one morning with their neck turned and can't straighten it up ... no history of trauma and often very apparent muscle spasm on physical examination

as for immobilisation in the ED it's only taken me 2 years to convice people that if you want to immobilise you do it there and then - i.e. collar and inline stabilisation at the initial assessment desk then controlled movement onto a trolley brought to the patient's side ... rather than walking them around the ED and then immobilising ....

[CAPMEDIC-EMWFR]

OK, that makes more sense. I apologize for what I said earlier, but without that extra information it did make the story sound like bullshit. My aplogies.

[Shelbmedic]

Thanks, Capmedic-EMWFD I accept your apology.

[PRPGfirerescuetech]

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.

Dwayne

Whoever reamed him/her is blatantly wrong.

What is the purpose of immobilization? To prevent further injury. In reality, one really cant even qualify this as a medical treatment. If its deformed, and you meet resistance, further movement could potentially cause the same fracture your trying to avoid.

So...

Immobilize in place, and accomplish the same goal as in line immobilization, without causing injury.

PRPG