# scenario with defib and spinal



## lacountylifeguard (Nov 2, 2009)

I was given this scenario at work yesterday:

-My partner and I see one person down on a dirt road; unwitnessed injury, thus suspected spinal
-No breathing, shockable heart rhythm
-We have full equipment with us (defib, c-collar, backboard, etc.)
-No bystanders are present

After scene safety, BSI, and calling for backup, I held in-line stabilization, which I was told is correct.  After the initial round of CPR, my partner hooked up the defibrillator and we wanted to shock, but I have been told that once I have in-line stabilization, I can't let go until the patient is on the backboard, but I clearly can't hold onto a patient when she's being defibrillated because it would shock me as well.  

What should we have done?  We could have c-collared and backboarded the patient and then shocked, but that would have taken a good deal of time and we wouldn't be doing CPR while we were backboarding.  We could have c-collared and shocked without the backboarding, but the c-collar alone isn't incredibly effective.  I could have let go of the head, shocked, and then grabbed the head again, but that would have defeated the purpose of in-line stabilization seeing as defibrillation jolts the entire body significantly.  Several people who saw the scenario seemed unsure of how to handle the situation--please advise.


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## Epi-do (Nov 2, 2009)

Airway, breathing, and circulation ALWAYS come first, and thus, trump c-spine immobilization/stabilization.  If the patient is dead, it really doesn't matter if they have a c-spine injury or not.  If the AED advised to shock, let go of c-spine and shock the patient.  Remember, life over limb.


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## Sasha (Nov 2, 2009)

> I held in-line stabilization, which I was told is correct.



Whoever told you that was correct was wrong. 

No point in holding C-Spine if they're dead. As Epi said it is life over limb. If you're holding C-Spine how can you guys effectively switch out after a cycle of compressions? Only one rescuer doing CPR lends to rescuer fatigue and bad CPR. If you have two people you should alternate who does compressions.

By the way, welcome to EMTLife.


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## JPINFV (Nov 2, 2009)

Can't let go? Show some jazz hands and proove that you can very easily let go.


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## thegreypilgrim (Nov 2, 2009)

lacountylifeguard said:


> After scene safety, BSI, and calling for backup, I held in-line stabilization, which I was told is correct.


 It's not "wrong" per se, but if it's just the two of you on scene it's kind of a waste if your patient is in full arrest.  





> After the initial round of CPR, my partner hooked up the defibrillator and we wanted to shock, but I have been told that once I have in-line stabilization, I can't let go until the patient is on the backboard,


 See, this is your problem. You're holding c-spine on a dead person whom now needs to be defibrillated. It's just simple triage man, what is their bigger problem? The fact that they're pusleless, apneic, and in a lethal dysrhythmia? Or that there may be some sort of spinal trauma? The former is _certainly_ going to kill them (actually, they _are_ already dead and you have this narrow window where you might be able to resuscitate them), the latter _may_ result in paralysis or some other neuro deficit. Holding c-spine in this scenario just isn't important - they need CPR and defib. 





> but I clearly can't hold onto a patient when she's being defibrillated because it would shock me as well.


 This is a common misconception. There is not enough energy in a DC countershock to transmit a lethal dose of electric current from the patient to you. The only way it can shock you is if you somehow place your hands between the defib pads/paddles. Still, it's best practice to not be touching the patient while they're being defibrillated, so your best course of action is to just let go of c-spine and shock.


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## Shishkabob (Nov 2, 2009)

Who cares about a broken spinal column if they aren't alive to complain about it?



Forget Cspine and do 2 person CPR.  You can put the c-collar on during compressions, but that should be all you need until you have ROSC. All inline stabilization is useless if they die anyhow.


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## mycrofft (Nov 3, 2009)

*Go with the panel on this one.*

Somewhere I have an article about delaying airway due to C SPine...
Current might not be lethal but I bet an instant replay would reveal some really intersting alignment going on.


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## WTEngel (Nov 5, 2009)

*I would let go and defib...*

Like everyone else said, let go, the apply some electrical therapy.

The victim may thank you in wheel chair, however, that beats the family wondering "what if."

On another note, as far as the electrical charge not being lethal to someone holding the patient....I don't want to be the first person to find out that it is. I would never hold on to a patient being shocked, plain and simple, and someone who advises me otherwise can take over c spine if they are that comfortable with it.


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## mycrofft (Nov 6, 2009)

*See my thread on second hand defib.*

Wear lineman's gloves? (No Glenn Campbell jokes). Just don't defib in the pool.


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## Akulahawk (Nov 6, 2009)

Would I willingly hold C-spine during a defib? No. If it were to happen, what's the possibility that I might get enough current through my myocardium to cause a problem? Pretty darned low. If you don't complete a circuit, you're not going to have the current flowing through you to cause the problem. Observe basic electricity safety rules for working on live lines and you'll most likely have a surprise, but nothing truly hazardous.

Ever held/worked on a live 120VAC 20A line without lineman's gloves? I have... not intentionally. Regardless, I observed precautions that prevented me from completing a circuit to ground. That means that while I was working on the line, I was actually energized and if I'd completed a circuit to ground... oops!


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## EMSLaw (Nov 6, 2009)

Yeah, this one is a no-brainer.  Do CPR.  Worry about c-spine later.  Especially since your MOI is just "man down, unwitnessed."  But even if it was a skydiving accident, you do CPR /first/, then deal with the cspine issues once the patient has a heartbeat.


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