Immobilize or not?

[BrushBunny91]

Thanks for going easy on me guys and understanding I am still a student
Am I correct in saying I would try to realign the limb once to better spint and if that fails then splint as is? I would take into consideration the patients level of comfort and not attempt to move a very serious open fracture
Yes, I would try to take other findings into account such as medical alert tags, pupil dilation/constriction, and objects found near the patient. But in the sole case of unconscious and unknown moi, I would attempt to c-spine.

 

[DesertMedic66]

Thanks for going easy on me guys and understanding I am still a student
Am I correct in saying I would try to realign the limb once to better spint and if that fails then splint as is? I would take into consideration the patients level of comfort and not attempt to move a very serious open fracture
Yes, I would try to take other findings into account such as medical alert tags, pupil dilation/constriction, and objects found near the patient. But in the sole case of unconscious and unknown moi, I would attempt to c-spine.

The point of realigning a limb is to regain a pulse (PMSC's) in the limb. If the limb has valid PMSC's then splint in place.

 

[BrushBunny91]

In the case of a serious fracture will I ask the patient to attempt the Motor of the pmsc?

 

[DesertMedic66]

In the case of a serious fracture will I ask the patient to attempt the Motor of the pmsc?

yeah. It may hurt them or it may not. Just have the pt do small movements. "sir/mam can you wiggle your fingers/toes for me?".

 

[Handsome Robb]

Why not? "Sir/Ma'am can you wiggle your toes/fingers?" they don't have to squeeze your fingers or do the push/pull or your hands to demonstrate motor function.


edit: Eff you firefite! haha

 

[BrushBunny91]

Thanks guys ^_^

 

[DesertMedic66]

Why not? "Sir/Ma'am can you wiggle your toes/fingers?" they don't have to squeeze your fingers or do the push/pull or your hands to demonstrate motor function.


edit: Eff you firefite! haha

Should have been faster. My GF says I'm always fast...

 

[Handsome Robb]

Should have been faster. My GF says I'm always fast...

Yea...thats definitely not something to go galavanting around the internet with :rofl:

 

[DesertMedic66]

Yea...thats definitely not something to go galavanting around the internet with :rofl:

Whoops.... h34r:

 

[BrushBunny91]

Should have been faster. My GF says I'm always fast...

I didn't know emts had a life outside of being a hero to find the time to keep a girlfriend

 

[DesertMedic66]

I didn't know emts had a life outside of being a hero to find the time to keep a girlfriend

Well the GF is an EMT student right now.. Haha

 

[BrushBunny91]

Are you her skills instructor?

 

[DesertMedic66]

Are you her skills instructor?

Uhhhh actually... :unsure:

 

[BrushBunny91]

:rofl:
Well I hope she's getting some extra skills practice! It would be a waste if not

 

[Tigger]

Yes, I would try to take other findings into account such as medical alert tags, pupil dilation/constriction, and objects found near the patient. But in the sole case of unconscious and unknown moi, I would attempt to c-spine.

Don't assume, assess.

Wise words I got from my boss yesterday. He's been a highly regarded athletic trainer for over 30 years now with more education than about any non MD I know.



Sent from my out of area communications device.

 

[BrushBunny91]

Assume makes an *** out of U and ME

 

[ksmith3604]

we use NEXUS. If the patient clears nexus we do not have to immobilize. As long as there are 1.no focal neurological deficits present, 2. no midline spinal tenderness, 3. No altered level of conciousness, 4. no intoxication present, 5. No distracting injury present. If any of these five things are noted, they MUST be immobilized. If all of those 5 are negative, bring em into the ER sitting on the pram and no one will say boo to you.

 

[usalsfyre]

we use NEXUS. If the patient clears nexus we do not have to immobilize. As long as there are 1.no focal neurological deficits present, 2. no midline spinal tenderness, 3. No altered level of conciousness, 4. no intoxication present, 5. No distracting injury present. If any of these five things are noted, they MUST be immobilized. If all of those 5 are negative, bring em into the ER sitting on the pram and no one will say boo to you.

Quick question, does your system define altered LOC and distracting injury. If not, how do you define it?

 

[hjscm]

i would be worried about the o2 sat being low and only on 3 liters. being beaten in chest i would listen to lung sounds. if he is short of breath with a low o2 wouldn't you want higher LPM?

 

[icefog]

I'd keep an eye on his breathing, too, first of all - even if something serious like a pneumothorax is highly unlikely and the SpO2 can be explained by the shortness of breath due to pain, cold fingers, bla bla. Breath sounds are what matters here.

As for immobilizing, I wouldn't, unless he displayed neuro deficits or expressed pain upon palpation of the spine. But I wouldn't roll my eyes at all if anyone immobilized, either - stick to the protocol and all's good. On the other hand, if my partner suggested it despite me saying there's no need, I'd do it his way and immobilize - I think the value in giving your partner the peace of mind is pretty important, and the discussions about whether or not it's warranted can wait. It's not like he's asking to do a cric on him.

To be honest, though, I agree with the others on this, even if your protocol says immobilize and you don't in this particular case (no specific indication), I don't think anyone's gonna be able to do more than whine as long as you can justify that decision.