ladyfirefighter36 Posted June 14, 2007 Share Posted June 14, 2007 Got a question. Nine year old female involved in an ATV accident. She was the driver, had on a helmet. Apparently hit a ditch, threw her off, landed on elbow. Enough force to cause major damage to elbow (later taken to higher treatment facility for pins in elbow). Board or not? Interested to see what some of you think. Yes, elbow was only injury. Family got her up walking around. Some questions were raised between ems providers and nurse at ER. Thanks Link to comment Share on other sites More sharing options...
ExplorerShane Posted June 14, 2007 Share Posted June 14, 2007 If when you mean board you mean backboard than yes I would have. You don't know any other injuries besides that elbow, but maybe she has back or neck damage? Sometimes people can't even tell they do because they are still in shock from the accident. Link to comment Share on other sites More sharing options...
BushyFromOz Posted June 14, 2007 Share Posted June 14, 2007 Meh, difficult to assess through your post. The staunch NEXUST in me thinks collect a board, do not pass go do not collect 200 dollars purely based on significant distracting injury. However nearly all patients will meet 2 or more of the criteria, and im not convinced the MOI is significant enough based on the info given, so it gets a tentative no from me Need more info :? Edited for stupid, stupid mistake.... :shock: Link to comment Share on other sites More sharing options...
rock_shoes Posted June 14, 2007 Share Posted June 14, 2007 Tough to say based on the information given. How fast was the ATV going at the time? Did the patient remember the entire incident without gaps? Did the patient hit her head neck or back? Did the patient have any indication of a concussion? Numbness or tingling in the extremities? Link to comment Share on other sites More sharing options...
VelvetMonkey Posted June 14, 2007 Share Posted June 14, 2007 From a current EMT student: Wouldn't it be better to put her on a board and not need it than the alternative? Especially from a liability standpoint? Link to comment Share on other sites More sharing options...
skibum Posted June 14, 2007 Share Posted June 14, 2007 I've been riding ATVs (2, 3, and 4 wheeled) for 20+ years now. From my personal experience I have found it takes a pretty significant impact to throw a driver from the vehicle. Based on that alone, I'd probably have done a standing take-down to error on the side of caution. Just my $.02. -skibum Link to comment Share on other sites More sharing options...
brentoli Posted June 14, 2007 Share Posted June 14, 2007 it takes a pretty significant impact to throw a driver from the vehicle. I would agree, you are on those pretty sturdy. If you are going fast enough be be thrown, then you have a good chance at other injuries. How else did she present besides the elbow? That would help out in this assessment. Link to comment Share on other sites More sharing options...
ERDoc Posted June 14, 2007 Share Posted June 14, 2007 Let's look at the NEXUS criteria: No midline cervical tenderness No focal neurologic deficit Normal alertness No intoxication No painful, distracting injury that might make them ignore their neck pain So, from what we were given in the original post, I think we can assume #1-4 are negative. The gray area is the last criterion. Does this girl have a distracting injury? We might need a little more description of the elbow. Was she in a lot of pain? How do you determine what is a distracting injury? I'll let you come up with your own opinions on that. Before I can say board or no board, I would need a little more info about the accident. Also keep in mind that the NEXUS criteria were developed and validated on an adult population, though a few smaller studies seem to confirm the validity of the NEXUS criteria in children. Here is what the original study designers considered a distracting injury: "Any condition that, in the examiner's judgement could be producing enough pain so as to distract the patient from another, particularly cervical, injury. Such injuries may include a long bone fracture, a visceral injury; a significant laceration, degloving injury or crush injury; large burns; or any other injury causing acute functional impairment." According to the CCS rules, this pt should be boarded. It is difficult to post the CCS rules because they are a little complex, so here is a link to a visual guide: http://www.aapsga.org/ajcm/2006/fall/pdf/a...6-article03.pdf According to the first box, this is a significant MOI (a collision involving a motorized recreational vehicle) so this pt should be boarded and get xrayed. This is one of those cases that shows the discrepancy between the 2 rules. Link to comment Share on other sites More sharing options...
mountainman999 Posted June 14, 2007 Share Posted June 14, 2007 I would consider the injury you describe to be a distracting injury and would immobilize the patient. Link to comment Share on other sites More sharing options...
ladyfirefighter36 Posted June 14, 2007 Author Share Posted June 14, 2007 Patient complained of no other injuries. Nothing else noted upon secondary exams. Elbow was swollen and painful. Parents say they heard a 'pop' when they got her up. Patient was alert and oriented. Not sure how fast she was going at the time. No LOC. No numbness or tingling in extremities. We have numerous ATV accidents a year. Per our protocol, all get backboarded, unless they want to sign a release (as per hospital's orders the last few years). Our thinking, especially with a 9 year old, is if they were thrown off or fell off hard enough to cause a significant injury as described then YES, she needs boarded, which we did. Nurse at the hospital questioned us for quite some time about WHY, and did it in front of the patient's parent. Parent commented that they were glad we took the extra precautions, than not. Nurse was irate that we had her on a backboard for a very minor isolated injury. As I stated before, she was later taken to another facility for more advanced treatments. Link to comment Share on other sites More sharing options...
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