Fall from 3 ft

[Tigger]

We use NEXUS.

I didn't see anything glaring that would make him fail it. The arm could be argued as distracting but if he's calm and cooperating with my assessment and not freaking out about that arm it's not a distracting injury.

Exactly. The mere presence of an additional injury does not make it distracting. Assess your patient and you know, use critical thinking.

 

[mycrofft]

This is a great quote

Second that as long as you are right and they are wrong.
Is that frequent?

Again, I will bet no one is assigned the job of yelling at the ambulance guys and ladies. Ask your boss who is supposed to be yelling at you.

I'll wait. Go on.

 

[NomadicMedic]

I find that nurses in the ED who may not be familiar with current EMS protocols are the ones that get the most huffy. Usually it's a traveler or a floater. Once one of our "regular" nurses explains what's going on, the nurse static disappears.

However, I have no issues with explaining to some snarky nurse why I did what I did.

I got 99 problems, but a nurse ain't one.

 

[unleashedfury]

I got 99 problems, but a nurse ain't one.

Should have thought of that before, the last two gf's I had were nurses...

I've noticed that the ones that are more in touch with EMS or the regular EMS guys that show up at the ED usually don't give us grief. its the Green Nurses whether fresh out of schools. or new to the ED.

 

[Brevi]

Is that frequent?

Getting yelled at or my right:wrong ratio?

 

[zzyzx]

Just like there are cookbook paramedics, there are cookbook nurses and doctors.

 

[mycrofft]

Getting yelled at or my right:wrong ratio?

Yes.

:lol:

 

[tim120865]

I agree with nurse

Any fall from no matter what height is considered a trauma, therefore requiring cspine immobilization. Any emt knows this. Now I’m not sure what they teach you in CFR class but....fall = trauma = cspine immobilization... period! better for your patient to take the side of caution .

 

[NomadicMedic]

Any fall from no matter what height is considered a trauma, therefore requiring cspine immobilization. Any emt knows this. Now I’m not sure what they teach you in CFR class but....fall = trauma = cspine immobilization... period! better for your patient to take the side of caution .

So, apparently you learned this in 1986? Not "every fall" is a trauma, and putting a fall patient in CSpine on the side of caution is simply wrong.

If you practice this way, you're in serious need of reeducation.

 

[Medic Tim]

Any fall from no matter what height is considered a trauma, therefore requiring cspine immobilization. Any emt knows this. Now I’m not sure what they teach you in CFR class but....fall = trauma = cspine immobilization... period! better for your patient to take the side of caution .

Please don't spread myth and dogma.
Do some reading on smr and Cspine injuries . Many places are goin away from back boards completely. The majority of services have some sort of Cspine rule out. Trauma does not = Cspine injury. Back and neck pain does not = spinal injury. There is overwhelming evidence showing smr does not work. More recent studies are showing it does more harm than good.

Don't be that guy who regurgitates your protocols or what your instructor said and take it as the only way to do something.

 

[mycrofft]

However, follow protocols where you work. And maybe work to change them.
=================================================
I was thinking. (grinding noise and smoke explained).

Here's a question: what does it matter if a nurse or someone at the ED "yells" at you because they disagreed about treatment?

Holding their opinions highly is probably a good idea, but….if you were a responding nurse you'd only be concerned about political fallout if, after discussion, you still knew you were in the right and following protocols.

 

[chaz90]

Any fall from no matter what height is considered a trauma, therefore requiring cspine immobilization. Any emt knows this. Now I’m not sure what they teach you in CFR class but....fall = trauma = cspine immobilization... period! better for your patient to take the side of caution .

Continuing on that line, fall=trauma=immobilization=prevent patient movement=RSI.

Seeing any flaws here? I seriously hope no one anywhere is automatically trying to ineffectively immobilize every single fall. Caution has nothing to do with applying a worthless and harmful intervention when it's not even indicated by the already dubious standards we have!

Realistically, aren't backboard and C-Collar use the only thing that separates EMT from FR in a lot of locations? New plan. I now want a FR taking care of me over an EMT that doesn't know better and tries to backboard me after I stub my toe.

 

[mycrofft]

But if my Accord was crushed in a multiple rollover, the doors are crammed shut and I'm unconscious, feel free to use spinal precautions to extricate me.

(Do we need a sign or medical alert tag saying "OK to board me PRN"?).:rofl:

 

[Medic Tim]

But if my Accord was crushed in a multiple rollover, the doors are crammed shut and I'm unconscious, feel free to use spinal precautions to extricate me.



(Do we need a sign or medical alert tag saying "OK to board me PRN"?).:rofl:

In those situations a board can make a great extrication tool. So can a scoop depending on its design. Once on the stretcher the boar is removed.

I want a no SMR tattoo. Haha

Seriously though. If I am ever in a wreck the responding crews will have a fight on their hands if they try to put me in smr.

 

[Medic Tim]

Continuing on that line, fall=trauma=immobilization=prevent patient movement=RSI.

Seeing any flaws here? I seriously hope no one anywhere is automatically trying to ineffectively immobilize every single fall. Caution has nothing to do with applying a worthless and harmful intervention when it's not even indicated by the already dubious standards we have!

Realistically, aren't backboard and C-Collar use the only thing that separates EMT from FR in a lot of locations? New plan. I now want a FR taking care of me over an EMT that doesn't know better and tries to backboard me after I stub my toe.

But.. But. ... My instructors brother Is friends with a guy who is cousins with a medic that didn't board someone and they died..... So board = magical force field that prevents injury.

The sad thing is I have heard similar from many providers..... Minus the magical force field part.

 

[chaz90]

But if my Accord was crushed in a multiple rollover, the doors are crammed shut and I'm unconscious, feel free to use spinal precautions to extricate me.

(Do we need a sign or medical alert tag saying "OK to board me PRN"?).:rofl:

Nope. Take my unconscious self out on a board as an extrication device, then leave a C-Collar on as a reminder only, and gently lift me on to the cot while minimizing movement as much as possible. Still less movement than sliding around on a slippery board that doesn't immobilize anything. Also, my spinal cord is probably already damaged or not, and nothing you are going to will change that.

 

[mycrofft]

And there are some crappy extrication tools, too.
No I'm not referring to EMT's as tools. Well, not all...:glare:

I was tapped to teach a vollie crew about using their bendable scoop board once, the type you could lock into a chair like configuration to "safely" extricate someone from a sitting position without resorting to a short board before the long board (It was 1981, go figure. I don't find them via google anymore).

So they sat me up in a pickup truck and tried to extricate me. They had thrown potlucks and pancake breakfasts to buy this, and someone had hand-sewn a naugahyde carrier for it. But once it was on, and this was before steering columns swung or telescoped (without fatal impact), they were unable to get me out without removing the bottom part, hence making it a short board.

They then showed me their KED, and left me in it for a minute. Good lesson about a good tool, but a little scary after I'd debunked their aluminum god.

Learn the tools, but never revere them.
(Emerald NE vollies, sorry if any of you are still out there!).

 

[pdxems]

I'd agree with making the best judgement on whether or not the injuries are distracting as it's tough to say from a paragraph. If he's up and walking with no spinal tenderness, why strap him down (especially considering lengthy transport times)?

 

[mycrofft]

I'd agree with making the best judgement on whether or not the injuries are distracting as it's tough to say from a paragraph. If he's up and walking with no spinal tenderness, why strap him down (especially considering lengthy transport times)?

Because they hate him? (haha)

HI from Molalla

 

[bmedic1681]

Under PHTLS guidelines unless there is a significant MOI, if the pt is A&0x4 walking and talking and no LOC there is no need to backboard or collar this pt…. However if upon arrival on scene you find a pt walking and talking with a significant head injury and stating neck or back pain a standing take down should be done….. Always checking neuro after each intervention….