A fall that the hospital gave me grief about

[kindofafireguy]

Actually, lots of people do.

And along that vein is a great saying:

"You can't fix stupid, but you can sure as hell knock it down and tube it."
-anonymous

 

[DesertMedic66]

And those people deserve to be slapped with a backboard and beaten with a nonrebreather.

fixed that for you

 

[firecoins]

If I want your opinion I will pull your chain

Who asked your opinion? Nobody.

 

[Epi-do]

Actually, lots of people do.

What can I say. There is way more stupid in the world than I have time to deal with. When I precept students, that is often a topic we talk about. We discuss how to pass the test "everyone gets high flow O2" but spend more time talking about how to determine who actually needs O2, how much, and what method of delivery is most appropriate. If they are never taught, they will never learn how to figure it out.

 

[Tigger]

I wonder how many "providers" realize that spinal injuries do not automatically indicate nervous system damage and are really just another fracture. You could "break" every vertebra in your body and being walking around with no deficits whatsoever, though I bet you'd be in some pain.

A backboard does nothing for these fractures but make it more uncomfortable. It's not preventing them from getting any worse because short of another significant insult, the fractures are not going to get any worst.

Here's my little spinal story:

I hit a tree skiing a few months ago and fractured my L4 and L5, there were no neuro deficits and I managed to convince the ski patrol to not immobilize me. Unfortunately once I laid down in the sled I could not get back up (too painful) and had to be transported to the hospital on a board sans collar and it was horribly uncomfortable and made the pain worse. When I asked the doc if I was a typical presentation he said absolutely and that the very fast majority of spinal fractures are quite stable.

I have no studies, though I have read a few of the ones that Aidey posted as well as the the National Association of Athletic Trainer's position statement on spinal injury care and wholeheartedly agree that we do it far, far too much.

 

[Veneficus]

Wow!!!! So many complaints on here I do not know where to start. First of all to the OP.... You did the right thing. Geriatric PT's never seem to present with text book signs and symptoms. Many play off their pain as simply getting old or hide their pain in fear of needing surgery. All of the studies I have read never involve geriatrics in them. They also never follow up on the case to see if spinal issues presented later and if they could be tied to the original event. Now on to those who are complaining.... If this same PT did not fall but did have a CC of lower lumbar pain. What would your treatment be??? No other complaints just the back pain. And lastly to those that don't like boarding people because it is a pain and makes their job harder.... Please for the safety of my family and others FIND A NEW CAREER!!!!!!

Actually,

I'd like to think I know a little about trauma and the care of it. I have been to skule a few years.

I seriously doubt the benefit of longboards.

They were an expert opinion based on a theory that has been discovered to have a lot of flaws in it.

The only reasons I can think of to use them at all is

a. because you are obligated to follow a protocol.
b. to help extricate somebody out of a space like a car, trench, etc.

A pillow splint is a legitimate prehospital immobilization device.

What if that "pillow" was a 6 foot long cot matress? (sort of like a giant vacuum splint concept don't you think?)

 

[Aidey]

Bloody hell do I miss full body vacuum splints. Those things are amazing for hip patients.

 

[Tigger]

Bloody hell do I miss full body vacuum splints. Those things are amazing for hip patients.

We have one at my sports medicine job and I would like to see it get used more. However it is very large and would be a bear to get out on the ice. We also struggled to make it work for supine spinals, finding it pretty much a much to use the scoop to get them onto it, do you have a better technique perhaps?

 

[ffemt8978]

A pillow splint is a legitimate prehospital immobilization device.

What if that "pillow" was a 6 foot long cot matress? (sort of like a giant vacuum splint concept don't you think?)

What about the old military litters that were two wooden poles with canvas between them?

 

[Veneficus]

What about the old military litters that were two wooden poles with canvas between them?

Probably not much difference there either as long as you were not almost bouncing out of it as you were being carried.

 

[mycrofft]

We used the folding canvas stretchers by Ferno Washington that were always stretched laterally but folded in half longitudinally, and a short board (didn't have KED, 1981 midwest) if extrication was from/through a limited space. AND care, plus good coordination moving and positioning the pt., as well as a Philly collar. No ER complaints, and pt was not bouncing around thanks to care and having the ambulance litter (gurney/cot/bed whatever) as close at hand as possible.

I am greatly heartened to be reading here (and hearing in training materials) the reasoning process: splint to move, not treat. I am starting to hear more reasoning going into spine boarding. Hate to lose a potentially important tool just because it is more limited than we were and are taught.