fall scenario

[reaper]

I think there are valid points either way. But if done correctly c-spine doesn't cause further injury. My point is better to cya. It does take a lot to prove neglect but in the states if you screw up and your in the private sector your agency will cut all ties. They claim that they will help you but the reality is there lawyers will help them not you. There are many ways to comfortably protect c-spine I just don't see why we shouldn't err on the side of caution.

I feel sorry for you, if you are going to have a career of CYA! These are not random studies. They have been proven over and over in multiple studies. NEXUS is used by almost every progressive service that wants medicine, not just cover our butts in court.

If you practice medicine with the most up to date information. You will never be successfuly sued for negligance. I know that you are new enough to be one that got caught in the scare tactics of ill informed instructors. Lawsuits are not common place in EMS. As long as you do your job and provide care to the set standard, you will not have to worry.

Immobilzation is not a new argument. These studies have been out for years. You need to push your system to catch up to 20th century medicine. You can not practice the "way it's always been" medcine forever.

 

[usalsfyre]

I have never heard of that effect on ICP but you can use towel rolls and a stretcher that will protect c-spine. I will check out the study but 10 minutes immobilized shouldn't cause harm. Studies are also relative. There are many studies that support the atkin's and south beach diet. MD's and PhD's sY it works but any one with a kinesiology degree are any health field degree can tell you those diets offer false positive results. You have to know statistics, how to read and understand if a study and its results are significant and whether the journal is a credible journal. I am not saying it isn't and I will check it out but too many take a study as gospel. Just because it is in a journal take it with a grain of salt. Ultimately use your judgement. My only point is trauma can be present w/o pain or deficits. If further injury occurrs it's your but on the line.

Your doing the paramedic equivalent of closing your eyes, sticking your fingers in your ears and shouting "lalalalalaaaaa" when presented with evidence that doesn't fit your preconceived notions. How would you feel if your physician did the same?

NEXUS was a gargantuan study that pretty well proved physical exam is a reliable, specific and sensitive tool (more so than plain radiography)when it comes to diagnosing c-spine injury. Furthermore many systems (including the entire state of Maine) have been using this tool for years without issue. So unless your physical exam skills are so subpar that you don't trust yourself to accurately assess for pain then you'll be fine. If your assessments are that sub par then you should probably seriously question your ability to work independently.

Furthermore skin breakdowns can occur in as little as 30 minutes, which is a more realistic minimum time frame for being on a board. ICP and interference with respiration have already been noted. Not to mention it's very painful to be immobilized for any length of time.

Your unfounded fears over legal liability are getting in the way of proper patient care if you think every minor trauma needs SMR precautions.

 

[Hellsbells]

Ive never been a large fan of immobilization when unnessesary. There is no need to cause a pt the increased pain of being strapped to a hard board if not totally warrented. In my urban area the guideline for a pt remaining on a board is 1 hour after arrival at hosp, so if the hosp is busy and has had a long tranport that can add up to well over an hour on the board.

Furthermore, Milehigh, you state that the board and collar is harmless if done properly...but also admit that you have transported a pt with their head attached to the cot? What do you think is going to happen in the event of a sudden stop or mvc when the head but not the body is immobile?

As to the original poster, I would say transport, but not a board and collar is warranted. The potential for a brain bleed is there. Was the pt in question on warfarin?

 

[Melclin]

http://emj.bmj.com/content/28/2/115.short?rss=1

Interesting article on risk stratification of minor head injuries in pts on warfarin.

 

[Smash]

MD's and PhD's sY it works but any one with a kinesiology degree are any health field degree can tell you those diets offer false positive results.

Sorry, off topic I know, but did I just see someone equate an MD or PhD with a Degree in Quackery?

 

[Aidey]

I'm not sure I would call it quackery. A Kinesiology degree does have applications in the various physical fitness fields (rehab, physical therapy, professional coaches etc).

 

[Veneficus]

Sorry, off topic I know, but did I just see someone equate an MD or PhD with a Degree in Quackery?

There is a growing body of minimally educated healthcare providers who think all that advanced education obtained by MD and PhDs is just academic. That their basic textbooks show the true way because they present information as absolutes in simplified concepts.

There is a reason most never obtain higher education themselves.

Biochemistry, it's such a wonderful thing when discussing diets.