Spinal Immobilization or Not ?

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Legal Eagle

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Called out to a 50 year old female patient with back pain. Patient is found lying on the couch. Head to toe finds pain in the back radiating to her neck, and weak strength in hands bi-laterally. Pain is 10/10, constant sharp pain, made worse by movement.
Patient has a history of ETOH abuse, woke up today with severe back pain. Patient is unsure of what caused the back pain and has been drinking today.
When asked states she didn't fall.
Spinal Immobilization required ?
 
Legal Eagle said:
Called out to a 50 year old female patient with back pain. Patient is found lying on the couch. Head to toe finds pain in the back radiating to her neck, and weak strength in hands bi-laterally. Pain is 10/10, constant sharp pain, made worse by movement.
Patient has a history of ETOH abuse, woke up today with severe back pain. Patient is unsure of what caused the back pain and has been drinking today.
When asked states she didn't fall.
Spinal Immobilization required ?
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i probably would have. If pain is made worse by movement then putting her on a board would elimate alot of movement (i know that you can still move on a spine board.) Granted it isnt very comfortable on the board. and with a history of ETOH abuse and the patient was drinking its easier to restrain the Pt on a backboard (Im not saying that all abusers and people who have been drinking should get restrained.)
 
I'm not a big fan of c-spine restrictions, I've had elderly patients who have fallen, but did not have any neuro deficits, midline pain, or distracting injuries etc that did not get c-spined.

I'd have to talk to and assess this Pt myself to make a definite descision either way. What's her med. history like other than the ETOH abuse? Any bruises, marks, cuts, bumps, etc on her body? Did she get black-out drunk and fall down a flight of stairs last night or last week and not remember?

With the bi-lateral hand weakness and 10/10 pain in the neck, I'd probably c-spine as a CYA technique, no way med control would clear c-spine on this for a Basic.

It all comes down to your judgment. Just make sure you can justify why you did or didn't c-spine. Follow your protocols and call med-control if you want to breach protocols.
 
If the patient has been drinking and has a neuro deficit they certainly don't meet my field clearance protocol and I'd be more than likely placing them in spinal precautions.

I mean, who really knows what happened? Did she fall down some stairs in the middle of the night while intoxicated? I wasn't there and she's not a reliable historian.

A collar and LSB seems to be indicated, at least to CYA.
 
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My instructor made it a point to remember "When in doubt, Board them up". I would much rather bring in a patient on a spine board who didnt need the board then bring in a patient not on a board who needed it.
 
firefite said:
My instructor made it a point to remember "When in doubt, Board them up". I would much rather bring in a patient on a spine board who didnt need the board then bring in a patient not on a board who needed it.
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Given the clinical decision tools available, there should be little doubt.

Unsure mechanism and positive NEXUS criteria? Board based solely on what's provided, but a better HPI could rule out c-spine.
 
to c spine or not to c spine??

Firefite said it the best.When in doubt,board em was my sediments exactly.My experience has benn that drunks tend to leave out certain little details you need to know.
 
Yup. Per my protocols, she gets a board. As everyone before has said ETOH makes her not a reliable source of information to to by. I had an abuser fall off of her bed once, walk to the couch, then call in the morning for neck pain. I didn't want to board her (big lady), but did as a CYA. Then it turns out she had a C2 (I think) fracture.
 
When in Doubt, whip em out..


BoardsCut_web.jpg



laerdal-c-collar.png
 
n7lxi said:
That's a shame, isn't it?
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It really depends... I know if I'm ever in an accident and opt for transport, I'm going to need a little more than a twinge of pain to submit to the placebo known as spinal immobilization.
 
JPINFV said:
It really depends... I know if I'm ever in an accident and opt for transport, I'm going to need a little more than a twinge of pain to submit to the placebo known as spinal immobilization.
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Same here. I am NOT A FAN of the whole spinal imob procedure.

However, that person with the neuro deficit and back pain, who admits to alcohol on board, who called 911, needs to be on a LSB with a collar. Until things change, that's the standard of care in my system (and I'm guessing in yours too.)
 
I think pretty much any protocol for selective spinal motion restriction uses ETOH as a disqualifier. In addition, the pt doesn't know how she injured her back. I don't really need to hear anyhting else. That alone is enough for me to initiate SMR.

Edit: If she's adamant about not getting a board and collar, then have her sign a refusal clause for that particular intervention before moving her, provided she demonstrates adequate decisional capacity.

"Legal Eagle?" First post? Are you an ambulance chaser feeing out the forum to see what's negiligent and what's not, for your client?
 
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n7lxi said:
Same here. I am NOT A FAN of the whole spinal imob procedure.

However, that person with the neuro deficit and back pain, who admits to alcohol on board, who called 911, needs to be on a LSB with a collar. Until things change, that's the standard of care in my system (and I'm guessing in yours too.)
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I agree. Back pain radiating to the neck with etoh on board. Immobilize for best patient care and cya. Plus there is less chance that the receiving ER Doc will chew you butt.
 
PotashRLS said:
I agree. Back pain radiating to the neck with etoh on board. Immobilize for best patient care and cya. Plus there is less chance that the receiving ER Doc will chew you butt.
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It's really more about the latter two reasons and less about the first.

But, right now it is what it is.
 
"Has been drinking today" isn't a whole lot of information, even with the history of abuse. Does having a beer mean that a person lacks capacity? If so, for how long? A person who has had a beer has "alcohol on board" and "has been drinking today."
 
JPINFV said:
"Has been drinking today" isn't a whole lot of information, even with the history of abuse. Does having a beer mean that a person lacks capacity? If so, for how long? A person who has had a beer has "alcohol on board" and "has been drinking today."
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Sure. And how many beers has EVERYONE had? Everytime you ask?

"Only two, sir."

Riiiiiiiight.

If you've had ANY alcohol, you've been disqualified from my selective spinal imob criteria.
 
So if I've had a beer, I lose the right to decline interventions? I, as a patient, don't have to meet a selective spinal imobilization protocol to decline immobilization. Personally, I hardly go past 1 beer when I drink, and almost never go past 2.
 
n7lxi said:
Sure. And how many beers has EVERYONE had? Everytime you ask?

"Only two, sir."

Riiiiiiiight.

If you've had ANY alcohol, you've been disqualified from my selective spinal imob criteria.
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That is a very dangerous line of thinking. Kidnapping is a pretty serious thing to have on your record.

Someone's had a single beer and they cut their hand while slicing lemons, someone sees a bunch of blood and calls 911. Dude who's cut just wants to AMA. Does the single beer mean they're blackout drunk and might have fallen down a flight of stairs?
 
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