thegreypilgrim
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Here in wonderful SoCal we are in love with c-spine. It's like our main form of treatment in EMS. Even though we have a spinal clearance protocol in pretty much every county, it's just one of those things that hasn't quite entered the realm of cultural acceptance. Oddly, and perhaps ironically, in my experience this is actually more on the hospital's end of things. Most providers I've responded with try to find ways to implement the spinal clearance protocol, often only to be chided about doing so by hospitals. Yesterday, I kind of got my first taste of that.
Anyway, I give you the following rather routine scenario and tell me what you think:
HPI: 83 year old female presenting to urgent care facility status post unwitnessed fall at home. Patient is amnestic to event and cannot definitively help you rule out syncope vs. mechanical fall. Currently patient is alert and oriented complaining only of tenderness to right temporal skull. Family is bedside and states that the fall took place about 2 and a half hours ago.
Vitals: BP 144/98, P 112, RR 18, SpO2 98% RA, BGL 263 mg/dL.
General: Well developed, appears comfortable. Seated in wheel chair.
HEENT: Approximately 2" laceration to right temporal skull which has not been closed. No other trauma. Pupils PERRLA. No dysarthria. Equal facial symmetry.
Neck: Trachea midline. No JVD. No tenderness on palpation. No vertebral step-offs.
Chest: Denies chest pain. No accessory muscle use. Clear and equal to auscultation bilaterally.
Abdomen: Denies tenderness. No rigidity, distention, or guarding.
Extremities: No edema, clubbing, or trauma noted. Equal grips/pushes. Positive circulation and sensory-motor function x 4.
Skin: Warm and dry.
PMHx: Diabetes, Atrial Fibrillation, HTN
Allergies: Penicillin, Morphine
Medications: Diltiazem, Coumadin, Diovan, Glyburide.
ECG looks something like this except a bit slower:
So, do you c-spine this patient or not? In case anyone asks, the urgent care has not performed any radiographic imaging, labwork, or provided any other interventions other than requesting your code 2 (no lights and sirens) response.
Anyway, I give you the following rather routine scenario and tell me what you think:
HPI: 83 year old female presenting to urgent care facility status post unwitnessed fall at home. Patient is amnestic to event and cannot definitively help you rule out syncope vs. mechanical fall. Currently patient is alert and oriented complaining only of tenderness to right temporal skull. Family is bedside and states that the fall took place about 2 and a half hours ago.
Vitals: BP 144/98, P 112, RR 18, SpO2 98% RA, BGL 263 mg/dL.
General: Well developed, appears comfortable. Seated in wheel chair.
HEENT: Approximately 2" laceration to right temporal skull which has not been closed. No other trauma. Pupils PERRLA. No dysarthria. Equal facial symmetry.
Neck: Trachea midline. No JVD. No tenderness on palpation. No vertebral step-offs.
Chest: Denies chest pain. No accessory muscle use. Clear and equal to auscultation bilaterally.
Abdomen: Denies tenderness. No rigidity, distention, or guarding.
Extremities: No edema, clubbing, or trauma noted. Equal grips/pushes. Positive circulation and sensory-motor function x 4.
Skin: Warm and dry.
PMHx: Diabetes, Atrial Fibrillation, HTN
Allergies: Penicillin, Morphine
Medications: Diltiazem, Coumadin, Diovan, Glyburide.
ECG looks something like this except a bit slower:
So, do you c-spine this patient or not? In case anyone asks, the urgent care has not performed any radiographic imaging, labwork, or provided any other interventions other than requesting your code 2 (no lights and sirens) response.
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