Question about Neck/Spine Injuries

[Handsome Robb]

Spinal Cord Injury

 

[Rescuelou123]

HEY AMELIA HI HOW ARE YOU. LISTEN IN TRUTH MOI DICTATES YOU IN THE WAY TO MAKING YOUR RIGHT CHOICE. IF YOU FIND THAT THE PTS. IS UNCONSCIOUS AND YOU DO YOUR FAST HEAD TO TOE ASSESSMENT AND FIND OUT THAT THE PT. BLEEDING OUT FROM IMPACT OR ABDOMINAL REGON IS RIGIDY CHANCES ARE THEY'RE BLEEDING INTERNALLY AND MANUAL C-SPINE IMMOBILIZATION IS SECOND TO TRAUMA.THE FIRST THING TO DO IS EXTRICATION THAT PERSON C- SPINE IS ALREADY COMPRIMSED ANYWAY BECAUSE OF THE MOI. YOU KNOW WHAT I MEAN.

 

[Rescuelou123]

I HOPE THAT I WAS HELPFUL

 

[Tigger]

MOI determines pretty much nothing.

Also after rereading that post several times, I do not know what you mean. At all.

No points.

 

[PotatoMedic]

MOI determines pretty much nothing.

Except for the national registry!

 

[Rescuelou123]

How can you say that Tigger. When you know that it's true. You roll up to an MVA and you see pt. Lugde over the steering wheel unconscious and the car is mangled up and the pt. Needs to be extricated. You are going to tell me that you not going to color that person and extricate fast.

 

[luke_31]

How can you say that Tigger. When you know that it's true. You roll up to an MVA and you see pt. Lugde over the steering wheel unconscious and the car is mangled up and the pt. Needs to be extricated. You are going to tell me that you not going to color that person and extricate fast.

There are studies out there that show MOI is not a strong indicator for possible spinal cord injuries. Look at roguemedic's blog he has studies on there that show MOI is a poor indicator of potential spinal cord injuries.

 

[Tigger]

How can you say that Tigger. When you know that it's true. You roll up to an MVA and you see pt. Lugde over the steering wheel unconscious and the car is mangled up and the pt. Needs to be extricated. You are going to tell me that you not going to color that person and extricate fast.

I really have no idea what you are saying. Your post is nonsensical and makes too many assumptions.

When I show up to a traffic accident, I prefer to assess the patient and treat those findings. Kinda like I do with well, all the patients.

 

[chaz90]

How can you say that Tigger. When you know that it's true. You roll up to an MVA and you see pt. Lugde over the steering wheel unconscious and the car is mangled up and the pt. Needs to be extricated. You are going to tell me that you not going to color that person and extricate fast.

Oh boy. Not really treating the mechanism at that point are we? Yes, even I would still be forced to COLLAR that patient, and yes I would get the patient out as safely and quickly as possible, but these choices are based on patient assessment rather than some nebulous concept of "MOI." If I arrive on scene of this very same call with the same damage to the vehicle and find the patient walking around outside without complaint and stable vitals, I would not board and collar this patient, would not call a Trauma Alert, and would likely choose to send him to the hospital BLS if he wanted to go at all.

 

[Ewok Jerky]

How can you say that Tigger. When you know that it's true. You roll up to an MVA and you see pt. Lugde over the steering wheel unconscious and the car is mangled up and the pt. Needs to be extricated. You are going to tell me that you not going to color that person and extricate fast.

I would be treating the patient because they are unresponsive not because of the mechanism.

You have obviously never rode up on the scene of a rollover where the occupants have self extricated and are walking around without injury. You treat your patient and your findings on assessment.

MOI is an indication of what to look for on assessment but does not trump clinical judgment.

 

[Carlos Danger]

HEY AMELIA HI HOW ARE YOU. LISTEN IN TRUTH MOI DICTATES YOU IN THE WAY TO MAKING YOUR RIGHT CHOICE. IF YOU FIND THAT THE PTS. IS UNCONSCIOUS AND YOU DO YOUR FAST HEAD TO TOE ASSESSMENT AND FIND OUT THAT THE PT. BLEEDING OUT FROM IMPACT OR ABDOMINAL REGON IS RIGIDY CHANCES ARE THEY'RE BLEEDING INTERNALLY AND MANUAL C-SPINE IMMOBILIZATION IS SECOND TO TRAUMA.THE FIRST THING TO DO IS EXTRICATION THAT PERSON C- SPINE IS ALREADY COMPRIMSED ANYWAY BECAUSE OF THE MOI. YOU KNOW WHAT I MEAN.

UNRESPONSIVENSS, OBVIOUS BLEEDING, AND ABDOMINCAL RIGIDITY ARE PHYSICAL ASSESSMENT FINDINGS, NOT MOI!!!!!

WHAT WOULD YOU DO IF YOU ROLLED UP ON A ROLLOVER MVC AND THE PATIENTS ARE OUT, WALKING AROUND, AND HAVE NO OBVIOUS INJURIES AND NO COMPLAINTS!?! WOULD YOU STILL TREAT THEM AS CRITICAL JUST BECAUSE THEY WERE IN A ROLLOVER!?!!?

AS OTHERS HAVE SAID, MOI DICTATES NOTHING!! PERHAPS ELEVATED SUSPICION OF SERIOUS INJURIES, BUT NOTHING MORE THAN SUSPICION!!!

MOI IS NOT A DIAGNOSIS!!!!!

 

[JPINFV]

I am glad I can help. But as far as documentation, you can document all that that you want, but if what is documented isn't pertinent to the pt, then it will be discredited in a court room. For this pt I would document something to the effect of; I was taught SOAP charting. If you are unfamiliar with what that is, please ask, I love to teach and help as much as I can:

ATF UNK AGE MALE INVOLVED IN MVA. UNK SPEED. FRONT AND SIDE CURTAIN AIRBAGS DEPLOYED, DEFORMITY NOTED TO STEERING WHEEL, DEFORMITY NOTED TO WINDSHIELD. VEHICLE HAS SEVERE DAMAGE TO DRIVER FRONT; DRIVER SIDE, DRIVER REAR. WITH APPROX 2 FT OF INTRUSION INTO PT DRIVER COMPARTMENT. NO OTHER VEHICLES; ON SCENE; NOTED TO BE INVOLVED IN MVA. PT IS UNCOUNSCIOUS/ ALERT TO PAINFUL STIMULI; GCS 6. SKIN W/P/D; DEFORMITY NOTED TO DISTAL EXTREMITIES. WITH FD ASSISTANCE EXTRICATION WAS COMPLETED; WITH PULSES INTACT BEFORE AND AFTER PT MOVEMENT, PT ATTEMPTS TO WITH DRAWL FROM PAINFUL STIMULI BEFORE AND AFTER MOVEMENT. ATTEMPT TO PUT PT HEAD AND NECK MIDLINE WHERE UNSUCCESSFUL DUE TO NOTED RESISTANCE. PULSES NOTED BEFORE AND AFTER ATTEMPT, SKIN W/P/D DISTALLY BEFORE AND AFTER. PT PLACED INTO FULL SPINAL PRECAUTIONS WITH TOWELS AND PILLOWS USED TO STABILIZE HEAD/NECK. HEAD-TO-TOE ASSESSMENT REVEALS COMPOUND FRACTURE TO L. FEMUR. BLEEDING CONTROLED WITH DRY; STERILE DRESSING. LEG SPLINTED TO SPINAL BOARD, TOWELS/PILLOWS USED TO FILL VOIDS. PULSES NOTED BEFORE AND AFTER SPLINTING. HEENT - UNABLE TO PLACE HEAD/ NECK MIDLINE. OPA PLACED TO MAINTAIN AIRWAY. V/S: BP: 96/62 HR: 126 RR: 6 @ 99% R.A.(PRIOR TO BVM VENTILATIONS) BREATHING ASSISTED WITH BVM @ 14/M WHILE CONNECTED TO 100% O2. PT TX TRAUMA CODE 3. BILAT IVS ESTABLISHED ENROUTE. L. ARM 18G N.S. LOCK; R. ARM 14G IV FLUIDS GIVEN W.O. BLEEDING STILL CONTROLED, V/S: BP: 106/70; HR 122; RR 14 ASSISTED 99% 15L O2. PT TAKEN TO BED 3 U/A TO TRAUMA CENTER. REPORT GIVEN TO PHYSICIAN. UNIT OOS DUE TO DECON.

This documentation still has a few holes in it that I would address, but that would be the general picture I would paint for this scenario.

Why the caps lock? If I ever find the person who trains people to document in caps lock I will kill them slowly and painfully.

 

[gotbeerz001]

Why the caps lock? If I ever find the person who trains people to document in caps lock I will kill them slowly and painfully.

Agreed. I think it stems from the notion that hand-written PCRs you are supposed to written in CAPS (for those with terrible hand-writing)...

 

[JPINFV]

Agreed. I think it stems from the notion that hand-written PCRs you are supposed to written in CAPS (for those with terrible hand-writing)...

Wait, hand written documentation is supposed to be in all caps? F that as well.

 

[Rescuelou123]

What

 

[Akulahawk]

The only thing that MOI tells you is where to look. Nothing more, nothing less. You do NOT base your treatment upon MOI. You base it on your findings. An extreme example of MOI telling you where to look woul d be if someone stubbed their toe on something, you wouldn't put the person in SMR. The stubbed toe MOI doesn't indicate an energy transfer that would compromise the spine. You would look at (perhaps) the ankle, mid-foot, and toes for potential injury.

Unfortunately the EMS system where I now work is well behind the times in this area and they generally require SMR for a lot of traumas. I hope that changes soon. In the ER, we try to get the patients off the board as soon as possible, so that's at least a plus.

 

[Rescuelou123]

Hey I know what to do on a MVA and I know all about moi ok. And for your information moi does dictate what treatment you need to give and do as well.

 

[Rescuelou123]

Also I want to point out to you mr. Or mrs. Emt if you roll up to an MVA and you see the driver alert but head laceration you mean your not going to collar the person.
Or you going treat for bleeding first and not worry about moi. And take a chance on paralyzing that person because your first thing you did was control bleeding you dumbbell

 

[Ewok Jerky]

Hey I know what to do on a MVA and I know all about moi ok. And for your information moi does dictate what treatment you need to give and do as well.

you were taught wrong...unless you want to blame your protocols. But since you are calling us dumbbells and arguing with us about it...

 

[NomadicMedic]

Ah @Louie Patrizi, ya almost got us.

I smell a troll.