# panic attacks in spinal cases



## josieful (Jan 6, 2015)

how would you handle this situation? more specifically patient 3.
My partner and I attended a job at 2am to a Marine Rescue vessel what had overturned (rough weather, the rescue boat hit something on the way out to assist another vessel, ripped the hull open and injured the 3 crew)

Advised there were 3 people on board, one with suspected spinal and the other two only minor injuries. marine rescue transported us out on their other vessel.

patient 1: 42yo male with broken arm, possible broken ribs
patient 2: 35yo male with a large gash to right thigh. already had pads on it to stem bleeding when we arrived.
patient 3: 20yo female, had been thrown in crash and was wedged between metal seat frames. as we arrived we are informed that she had anxiety and panic attacks. After spending a few minutes calming her down my partner was able to get her to talk to him whilst I attended to the other two patients. On assessment we determined a slightly altered mental state (with the help of one of the people she worked with), a fractured hip, and were 95% sure she had fracture in the small of her back. Ended up as a full spinal even though patient resisted. She was shaking most of the time and it was hard to get her to engage in any conversation.

As I was a 40 min boat ride back in rough weather, her pain was only just manageable- we made the call to sedate her which was a very difficult process.

My question is how would you go about managing a full spinal patient who was so terrified to the point of resisting anyone touch them? Any advise for next time? How do you get them to trust you enough to get a collar on and get them on the board and strapped down?


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## STXmedic (Jan 6, 2015)

Don't. The collar should be easy enough to convince, but if they're that panicky about the board, then don't board them. Yes, even with a fairly certain spinal fracture. The cot mattress does a better job at preventing movement anyway.

As for the "cya" portion of that, have her sign a refusal of that procedure. If she can't for whatever reason, document that because of her anxiety and mental status, the patient would not tolerate the board, so she was not placed on it to prevent further harm. Something to that effect.


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## Ewok Jerky (Jan 6, 2015)

What he said.

If the patient refuses, and you  inform of risks, then document patient refused or patient uncooperative. 40 minutes on a board with a broken hip and maybe spinal fracture, while traveling through rough seas is not my idea of a comfortable ride. Add in some motion sickness or head injury and now you have airway compromise.  Add in a panic attack and you have a potential major safety issue.  It's in everyone's best interest to educate the patient and "immobilized" in position of comfort.


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## josieful (Jan 7, 2015)

The only problem with using the stretcher is we don't take the stretcher on the boat, we only take a spinal board. They lower the chart table and seat and the board sits on top of that.


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## Noncreative (Jul 2, 2015)

Yeah, inform the PT that you suspect a spinal, and inform them of the risks, and if they're competent and informed they can refuse care.  Documentation would be key, but it doesn't stop you from constantly trying to convince the PT to submit to backboarding.  Although I can't think of many things worse than being strapped to a board on rough seas.


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## RedAirplane (Jul 5, 2015)

Speaking as someone who has previously been through panic attacks as well as a provider who has dealt with them...

If the patient is not actively dying but is actively panicking, some basic calming strategies work wonders.


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## NomadicMedic (Jul 5, 2015)

Ativan, FTW.


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## RedAirplane (Jul 5, 2015)

DEmedic said:


> Ativan, FTW.



A great drug. Although I find the 1987 ad for the drug (as seen on Wikipedia) a bit disturbing.

I once brought in a restrained, combative patient. The RN didn't believe me, undid the restraints, and promptly got a black eye. Next up, Ativan!


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## phideux (Jul 7, 2015)

On a boat like that, sometimes they have those life vests with the hard foam that are pretty rigid, if they do, maybe you could lay her on the deck with one of those as an improvised KED, put her on the board at the dock to get her off the boat, she would probably be alot calmer that way instead of fighting with her and trying to keep her boarded and tied down for a 40 minute boat ride.


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