would you c-spine?

[AnthonyM83]

I love when people C spine after the patient has already been ambulatory for an extended period of time.

The patients with spinal fractures do too. We've had a number of local incidents of people walking in to ER's with potentially dangerous spinal fractures secondary to BLUNT trauma. Most of the ones that involved prehospital personnel, they had cspined them anyway, so they were in the clear. Not all, though.

Penetrating is a different story...

 

[MediMike]

+1 to the post above. We've had several patients in the last two years walk into the ED after slipping down stairs etc., ambulatory for 4-5 days, get films and found to have unstable fxs. Nexus.

 

[Veneficus]

After reading this thread...

There is no hope for EMS...

 

[VFlutter]

The patients with spinal fractures do too. We've had a number of local incidents of people walking in to ER's with potentially dangerous spinal fractures secondary to BLUNT trauma. Most of the ones that involved prehospital personnel, they had cspined them anyway, so they were in the clear. Not all, though.

Penetrating is a different story...

So for those patients who were ambulatory do you think it would be better to backboard them over transporting them in position of comfort? What did they do when they got to the ER? Full immobilization?

 

[rescue1]

Hospital staff readers: if a patient comes to the ER with a complaint suggesting spinal injury, are they immobilized? And if an xray shows a fracture are they then immobilized? In my experience they are not, which makes me wonder why we get so worked up about it prehospitally.

 

[Handsome Robb]

Hospital staff readers: if a patient comes to the ER with a complaint suggesting spinal injury, are they immobilized? And if an xray shows a fracture are they then immobilized? In my experience they are not, which makes me wonder why we get so worked up about it prehospitally.

You figure out the answer to that you let me know. We are one of the last, if not the last countries using the long spine board rather than a collar and scoop or something of the sort.

I'll echo usalsfyre and say: if you are worried about a spinal injury...NEXUS

I'll echo Tigger as well and say: assess your patient.

 

[Medic Tim]

Hospital staff readers: if a patient comes to the ER with a complaint suggesting spinal injury, are they immobilized? And if an xray shows a fracture are they then immobilized? In my experience they are not, which makes me wonder why we get so worked up about it prehospitally.

What I normally see is a c collar and the pt is put in a position of comfort(in a bed) and told to not move.



I understand the some places do not have spinal rule out but don't you need to have a suspicion there may be an injury before you put the pt on a board. (Assessment) Since when has a fall from standing height been a significant moi? Especially if there are no neuro deficits or pain(I know that was not the case here but I see it all the time)

 

[rescue1]

Technically per PA state protocols a fall from standing is considered significant MOI. However, if the pt denies pain and is not altered (basically, NEXUS), then c-spine can be cleared.

As for the hospital thing, that's what I figured.

 

[Medic Tim]

Yup would get the board and padding.

Think about the MOI and the force of energy transfer. PT fell on butt where is the energy going to travel? It is going to go up his spine. Possible (unlikely) spinal injury further up the spinal column as a result of transfer of energy. Injury more likely if pt had sever curve in spine (i.e. looking down) or kyphosis. What if pt had prior back injury? Could definately reagravate it. Most likely this is why you got some flack from the ER.

Pt would be c-spine and backboarded. Heavy padding. Of course, our hospitals clear pts. off of backboards quickly.

You need to look at the pt and perform a good assessment. Not look at the (questionable) significant moi, What is the sense of you even doing an assessment if you are not going to use the findings. Just because a pt fell or even hit their head does not mean they need a board. And doing it to be "safe" Is flawed thinking as putting them on a board will be worse(in most situations) than having the pt find a position of comfort and sit still. Show me a study or evidence that it does (becuase we have always done it is not an answer) this is one of the areas where ems needs to catch up with the rest of the medical field
A pt with "sever curve in spine" as you call it is even more reason not to put this pt on the board. With a pt like this if I suspected a c spine injury, would get a collar and transport in a position of comfort.(not on a long board)

 

[Medic Tim]

Technically per PA state protocols a fall from standing is considered significant MOI. However, if the pt denies pain and is not altered (basically, NEXUS), then c-spine can be cleared.

As for the hospital thing, that's what I figured.

Hopefully ems will catch on to the whole evidence based thing sometime this century.

 

[rescue1]

Hopefully ems will catch on to the whole evidence based thing sometime this century.

Your crazy talk of science has no place here, sir.

 

[Medic Tim]

Your crazy talk of science has no place here, sir.

Oops, I forgot I am only an ambulance driver.

 

[Veneficus]

easy answers

Hospital staff readers: if a patient comes to the ER with a complaint suggesting spinal injury, are they immobilized? And if an xray shows a fracture are they then immobilized? In my experience they are not, which makes me wonder why we get so worked up about it prehospitally.

You get worked up about it because the people teaching teach what they know.

They were taught fear instead of knowledge and they pass that on.

They were taught that a spineboard actually stabilizes the spine, which is pretty much BS.

What is does do is reduce spinal motion during extrication.

It is left over from a time when people were guessing what helps with exponsentially less knowledge than we know today.

 

[Christopher]

+1 to the post above. We've had several patients in the last two years walk into the ED after slipping down stairs etc., ambulatory for 4-5 days, get films and found to have unstable fxs. Nexus.

I would argue that those Fx are by definition stable as the patient had no sequelae after 4-5 days...but hey I'm just an engineer not an orthopod.

 

[ExpatMedic0]

I was not there but if the person is elderly and is complaining of 10/10 pain even from a ground level fall I would not be so quick to dismiss the idea. I would really at least consider a possible fracture until proven otherwise. I have seen elderly women with fractures from ground level falls. Of course many factors may play a roll in deciding to backboard or not.

 

[usalsfyre]

I was not there but if the person is elderly and is complaining of 10/10 pain even from a ground level fall I would not be so quick to dismiss the idea. I would really at least consider a possible fracture until proven otherwise. I have seen elderly women with fractures from ground level falls. Of course many factors may play a roll in deciding to backboard or not.

Not unheard of...but is a board going to help clinically in any way?

 

[VFlutter]

i would argue that those fx are by definition stable as the patient had no sequelae after 4-5 days...but hey i'm just an engineer not an orthopod.

+1000

 

[ExpatMedic0]

Well that all depends on what was suspected based primarily on the assessment and of course other factors like hx, moi, ect.

What are we suspecting? Based on the limited information regarding the physical examination and having not been there myself. I am not sure if I should suspect a fractured coccyx, pelvis, something even more serious or simply a soft tissue injury. I do not think at least seriously entertaining these ideas, and ruling them out is a bad idea, do you?

Maybe a backboard with padding, maybe a KED, maybe a pelvic sling, maybe just some padding with position of comfort.

 

[usalsfyre]

But the board still doesn't particularly help an injured spine in any way. I think it could probably be safely argued the stretcher mattress does a better job of reducing spinal movement than a board.

 

[ExpatMedic0]

So your arguing against the use of a backboard for any spinal immobilization procedures, or just for this scenario?