# Simple tricks



## el Murpharino (Feb 25, 2008)

So in my refresher class the other day, I heard of a pretty simple way to "pad the void" in the lower back when your patient is on a LBB - use the thigh BP cuff, slide it in while it's flat, and pump it up until your patient has relief.  It's so simple I almost felt dumb not thinking of it myself at some point.  Anyways, I figured I'd ask around and see if there were any other simple solutions people had to common problems like this.  Thanks.


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## skyemt (Feb 25, 2008)

BP cuff could leak under pressure of someone lying on it... if that matters to you...

why is it better than a towel or blanket?


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## certguy (Feb 25, 2008)

Padding under the knees or , if possible , having the pt. bend thier knees also helps .


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## BossyCow (Feb 25, 2008)

I'm not sure I would do this. The cuff could become unstable because of a leak or because someone accidently deflated it. I like a more stable material, like a towel. Also, on a less technical level, a bloody towel stays at the ER and is cleaned by the hospital laundry, the bloody BP cuff has to come back to the station in a biohazard bag and is cleaned by me.


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## el Murpharino (Feb 26, 2008)

skyemt said:


> BP cuff could leak under pressure of someone lying on it... if that matters to you...
> 
> why is it better than a towel or blanket?



If you remember to put a towel or blanket under there when backboarding, it probably isn't any different, but if you're stuffing towels or a blanket underneath them while on the backboard, enough at least to provide relief, your patient will most likely end up shifting a bit one way or the other....defeating the purpose of total immobilization.  I'm not saying inflate the BP cuff to it's maximum capacity; only enough to provide some relief.  The thigh cuff is pretty durable...most of the lumbar support mechanisms on vehicle seats are essentially air bladders.  It's not an 'always-use' mechanism anyways.  As always, use some judgement.


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## skyemt (Feb 26, 2008)

el Murpharino said:


> If you remember to put a towel or blanket under there when backboarding, it probably isn't any different, but if you're stuffing towels or a blanket underneath them while on the backboard, enough at least to provide relief, your patient will most likely end up shifting a bit one way or the other....defeating the purpose of total immobilization.  I'm not saying inflate the BP cuff to it's maximum capacity; only enough to provide some relief.  The thigh cuff is pretty durable...most of the lumbar support mechanisms on vehicle seats are essentially air bladders.  It's not an 'always-use' mechanism anyways.  As always, use some judgement.



as i'm sure you know from using bp cuffs... inflate one, and check back 5 minutes later... it will not have the same inflation... most of them will leak slightly over time... i just don't get why this is a better idea than a rolled blanket or towel... do you really want to keep checking the thing for leaks?

makes no sense to me. there are better alternatives.


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## EMTBandit (Feb 26, 2008)

I would just rather stick to the good old towel or blanket. Hasn't failed me yet. It's a lot easier to deal with, easily replaceable, and gets thrown out. Using a cuff just sounds like more trouble than it's worth.


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## el Murpharino (Feb 27, 2008)

skyemt, I think I answered why using towels or blankets could be detrimental to the patient.  I'm not going to beat a dead horse.  Again, I'm not saying the thigh cuff is going to maintain a constant pressure, or is the holy grail of backboarding management.  But what it will do is provide some relief to someone on the LBB without having to shove something under them and invariably shifting them around and potentially worsening a spinal injury.  I'm not going to defend whether or not a BP cuff is useful or not anymore; I have used it several times in the past with positive results.  You can stick to stuffing towels or blankets under your patients.  Towels and blankets are perfectly acceptable standard and I'm not questioning the tactics of such.  That's not the point of this thread.  It is to get other simple tips and tricks.


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## skyemt (Feb 27, 2008)

simple tricks and tips implies that it is a better way than the tried and true way...

sorry, but as many on this thread have stated, yours does not seem to fit the bill...

however, no need to get defensive! to each his own.


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## BossyCow (Feb 27, 2008)

Yep.. I'll stick with what works and the towels work.  Of course, I suppose, using the thigh cuff may be better than inserting towels incorrectly and jarring the patient but done correctly towels work well. Besides it means I don't have to disinfect the thigh cuff. 

Also, besides the tendency of them to leak, there's the very real possiblity that the cuff could be accidently deflated by someone going to take a pressure enroute and grabbing the wrong bulb. An inflated thigh cuff is unstable by its very nature. 

Do you document on your report that the lower back was stabilized with a thigh cuff? From a liability standpoint, it sounds like a risk. You are using something for a purpose that it was not intended. Lawyers love that.


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## Jolt (Feb 27, 2008)

Okay, I'll throw in a trick I've learned that probably everyone is aware of just so the topic can shift.

When you're working for one of the cheaper departments that likes towels instead of those fancy commercial headblocks, and you want to secure your patient's head to the board with tape, you can use one long piece of tape instead of two pieces of tape on the forehead and chin.  You do this by putting the towel rolls inn place, and having someone lift the board.  Then you stick part of the tape to the bottom of the board up near the forehead, tape across the forehead (make sure not to pull the patient's head with the tape), stick the tape to the bottom of the board, go diagonally across the bottom of the board, coming back up and taping across the chin, and finishing off the piece of tape by sticking it to the side of the board opposite where you started the part that goes across the chin.

Maybe it's stupid, but it seems to secure the head much better than the two pieces that we were taught to use in class.

STOP TALKING ABOUT THE THIGH CUFF ALREADY!


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## skyemt (Feb 27, 2008)

ok... what happens if you need to make an adjustment by the neck, or across the head... you have to take the whole darned thing apart??

i just don't see that one either...

there is a reason that two separate straps are used, and it's the same reason two separate pieces of tape are used...

i'm all for tips and tricks... but why reinvent the wheel... i don't want to be going over and under boards when i can just simply go across... again... think about the adjustments you may have to make...


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## omak42 (Feb 27, 2008)

Going back to the bp cuff thing real quick....if you are that concerned about patient comfort, then perhaps your agency should look at investing in inflatable back rafts.  They are real simple to use, you just throw it on the backboard, tape it down (comes with a strap of taped on the bottom of the raft), ope the valve, pump it up, then close the valve.  They work surprisingly well.  I work for a very rural agency and our transport times range from about 25 min to 2 and half hours.  I have never had a problem with them deflating, and they conform to the patients whole body, so it doesnt only relieve the lower back.


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## Jolt (Feb 27, 2008)

skyemt said:


> ok... what happens if you need to make an adjustment by the neck, or across the head... you have to take the whole darned thing apart??
> 
> i just don't see that one either...
> 
> ...



That one piece of tape very easily becomes two pieces of tape with one quick cut from your trauma shears.  You can grab another piece of tape after that if you have to make your adjustments.


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## skyemt (Feb 27, 2008)

Jolt said:


> That one piece of tape very easily becomes two pieces of tape with one quick cut from your trauma shears.  You can grab another piece of tape after that if you have to make your adjustments.



of course! i know that! so your simple trick involves me now needing trauma shears and more tape!!

so, so silly.... two pieces of tape never went wrong for anyone. no trauma shears needed!

simple tricks and tips???


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## emtskibum (Feb 27, 2008)

Jolt said:


> That one piece of tape very easily becomes two pieces of tape with one quick cut from your trauma shears.  You can grab another piece of tape after that if you have to make your adjustments.



who needs trauma shears to cut tape????


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## el Murpharino (Feb 27, 2008)

omak42 said:


> Going back to the bp cuff thing real quick....if you are that concerned about patient comfort, then perhaps your agency should look at investing in inflatable back rafts.  They are real simple to use, you just throw it on the backboard, tape it down (comes with a strap of taped on the bottom of the raft), ope the valve, pump it up, then close the valve.  They work surprisingly well.  I work for a very rural agency and our transport times range from about 25 min to 2 and half hours.  I have never had a problem with them deflating, and they conform to the patients whole body, so it doesnt only relieve the lower back.



I've never heard of these things...but knowing the powers that be at my agency, they'd say "thanks, but no thanks".  But it's a heckuva idea...if agencies actually made patient care and comfort a priority over the bottom line.


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## omak42 (Feb 28, 2008)

el Murpharino said:


> I've never heard of these things...but knowing the powers that be at my agency, they'd say "thanks, but no thanks".  But it's a heckuva idea...if agencies actually made patient care and comfort a priority over the bottom line.



I would hope that all agencies would put the patient care and comfort over any other matter, since that is what we are here for.....but sadly, I know you are right.  I did check briefly into them and the pump for the is about 8 dollars and the rafts themselves are about 18....but perhaps it would be something to mention to your officers....I would strongly suggest you try, especially if your transport times are anywhere close to ours....good luck


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## Jolt (Feb 28, 2008)

skyemt said:


> of course! i know that! so your simple trick involves me now needing trauma shears and more tape!!
> 
> so, so silly.... two pieces of tape never went wrong for anyone. no trauma shears needed!
> 
> simple tricks and tips???



It went wrong for everyone in my EMT class at some point.  Gloves and tape stick together really well, and my method doesn't involve touching the sticky side with a gloved hand.

We could keep doing this I guess.  Let's just agree to disagree.


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## JPINFV (Feb 28, 2008)

el Murpharino said:


> I've never heard of these things...but knowing the powers that be at my agency, they'd say "thanks, but no thanks".  But it's a heckuva idea...if agencies actually made patient care and comfort a priority over the bottom line.



A company can't provide patient care if the company can't pay the bills. As much as the bottom line might suck at times, it is something that has to be taken into consideration.


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## omak42 (Feb 28, 2008)

Jolt said:


> It went wrong for everyone in my EMT class at some point.  Gloves and tape stick together really well, and my method doesn't involve touching the sticky side with a gloved hand.
> 
> We could keep doing this I guess.  Let's just agree to disagree.



If you want to get technical....the wrapping tape method is a bad idea.  Physically when going from one side to the other with the tape you have a high risk of turning the patients head.  You SHOULD be taught to rip a strip off and apply it to the forhead first, then secure both sides under the board at the same time.  This is the only way I would want to have it done to me, so its the only way I will ever do it with a patient.  I really dont see how wrapping tape around the board and patient is going to save you much time at all.  You should be able to rip a piece off apply it to the forhead, rip another peace off and apply it to the chin in a decent amount of time.  If not then perhaps you should work on getting faster at it, instead of trying to find a shortcut.


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## omak42 (Feb 28, 2008)

JPINFV said:


> A company can't provide patient care if the company can't pay the bills. As much as the bottom line might suck at times, it is something that has to be taken into consideration.



Oh I know this, and by no means am I saying that they shouldnt worry about bills.  Its just based on the way he worded the statement, I took it to mean that the "evils that be" would turn it down in order to keep more money instead of using it to comfort the patient.  I merely meant that instead of worrying about making as much money as the company can, then should worry about making the money they need and do what they can to make the patient more comfortable.  If they arent willing to spend a little bit more money (if they can afford it) in order to make things better for the patient, then I dont think I would want to be working for an agency like that.  We are in this field to put the patients priorities right behind our safety...not how much money we can make.


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## Grady_emt (Feb 28, 2008)

omak42 said:


> If you want to get technical....the wrapping tape method is a bad idea.  Physically when going from one side to the other with the tape you have a high risk of turning the patients head.  You SHOULD be taught to rip a strip off and apply it to the forhead first, then secure both sides under the board at the same time.  This is the only way I would want to have it done to me, so its the only way I will ever do it with a patient.  I really dont see how wrapping tape around the board and patient is going to save you much time at all.  You should be able to rip a piece off apply it to the forhead, rip another peace off and apply it to the chin in a decent amount of time.  If not then perhaps you should work on getting faster at it, instead of trying to find a shortcut.



Why do you have to worry about the pt head turning if you are still properly holding C-Spine until the head is secured???


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## Ridryder911 (Feb 28, 2008)

I have to admit some of those items are nice, but alike anything else things cost $$. Maybe the emphasis would be using common sense. We use the disposable head immobilizer that has duct tape type immobilizer. Common sense is to remove your gloves when applying the tape. 

The padded LSB is a nice concept, but not practical on most patients. In fact, I am surprised they are still available at that costs. Instead of LSB so many we researched and presented C-spine clearing techniques for field thus eliminating the use of LSB/C-collar on many (we still LSB about 10 -15 a day) as well as ER physicians are now quite aware a patient should not be on a LSB for > 30 minutes. They actually are usually removed from LSB almost immediately upon arrival (unless they specifically c/o C-spine or have neuro symptoms). 

Personally, I have never seen success with "wrapping" nor would I suggest such. More asking why? As well, I NEVER secure the chin, rather across the rigid cervical collar. Head injury patients tend to have associated N & V and attempting to remove chin strap on a vomiting patient is difficult and increases risks of aspiration. 

Most EMT's are ignorant on true application of immobilization. Padding using blankets, especially on bony prominences and joint areas. Many do not pad between straps which allows the straps to be tight and secure the patient even more so. 

I suggest reviewing JEMS articles for more suggestions of "tricks of the trade".


R/r 911


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## Outbac1 (Feb 28, 2008)

Speaking of tape. Does anyone put tape on their leg to write on? I often have a roll of white 2" tape, (3M Durapore), stuck to the dash, (left of the air bag), to write notes on. I sometimes will put a 6" - 10" strip on my thigh to use as an instant note pad. On some calls it is totally filled with pt. notes and others it doesn't have a mark on it. Just depends how the call goes.


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## skyemt (Feb 28, 2008)

Ridryder911 said:


> I have to admit some of those items are nice, but alike anything else things cost $$. Maybe the emphasis would be using common sense. We use the disposable head immobilizer that has duct tape type immobilizer. Common sense is to remove your gloves when applying the tape.
> 
> The padded LSB is a nice concept, but not practical on most patients. In fact, I am surprised they are still available at that costs. Instead of LSB so many we researched and presented C-spine clearing techniques for field thus eliminating the use of LSB/C-collar on many (we still LSB about 10 -15 a day) as well as ER physicians are now quite aware a patient should not be on a LSB for > 30 minutes. They actually are usually removed from LSB almost immediately upon arrival (unless they specifically c/o C-spine or have neuro symptoms).
> 
> ...



Rid, we have many geriatric patients, and as of yet we don't have a protocol that lets us "clear" many pts in the field (one is coming in a few months, but it still won't really clear those over 70)...

our transport times are about 20 min... don't you think the LSB padding (or raft) would be beneficial for our older patients?

if i am off target, please let me know...

it pains us to have to board those over 70, but sometimes we just don't have a choice...


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## Jolt (Feb 28, 2008)

Just to clarify... I don't tape the chin itself; I tape the chin part of the c-collar.  You also have very little chance of torquing the neck if you unroll the piece of tape first and bring it down to stick it.

Alright, I think I'm done defending this.


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## firetender (Mar 1, 2008)

All I know is I laughed at how the thread entitled "Simple Tricks" demented into "Simple Tricks Don't Work!"


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## Doctor B (Mar 1, 2008)

Outbac1 said:


> Speaking of tape. Does anyone put tape on their leg to write on? I often have a roll of white 2" tape, (3M Durapore), stuck to the dash, (left of the air bag), to write notes on. I sometimes will put a 6" - 10" strip on my thigh to use as an instant note pad. On some calls it is totally filled with pt. notes and others it doesn't have a mark on it. Just depends how the call goes.



+1  I do the same thing on my complex flights or inter-facility transports. Another good location is on the opposite forearm of your writing hand so if you're taking notes while standing you don't have to bend over to write on your thigh.


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## Gbro (Mar 1, 2008)

Jolt, 
I agree with your tip, as I have done this many times. That strip of tape is usles in many situations. Even when i do use the strip i will a lot of times use a full wrap over it.
Its a practice thing. if you use good stabilization and alignment. This can be done successfully.


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## OnceAnEagle (Mar 3, 2008)

I was a fan on writing on my forearm, as some have mentioned, until a warm day and CPR lead to me having a black streak across my forehead from wiping the sweat away.

Now, the back of the glove works wonders assuming it's not particularly messy to that point.


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## Airwaygoddess (Mar 4, 2008)

2 inch cloth tape on top of your thigh, works pretty well for the basic info! ^_^


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## emtwacker710 (Mar 5, 2008)

BossyCow said:


> ...Also, on a less technical level, a bloody towel stays at the ER and is cleaned by the hospital laundry, the bloody BP cuff has to come back to the station in a biohazard bag and is cleaned by me.



I agree with this also, I would much rather leave any biohazardous materials at the hospital instead of bringing them back with me to my squad building.


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## emtwacker710 (Mar 17, 2008)

Airwaygoddess said:


> 2 inch cloth tape on top of your thigh, works pretty well for the basic info! ^_^



yes it does, I also carry one of those small pocket sized notebooks so i can grab basic info on scene from family members if it's a bad call and dont have time to start the PCR


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