# Drawing the line with head injuries



## chri1017 (Jul 18, 2013)

Out of curiosity where do most people draw the line with spinall immobolization and a minor head injury.  Say you had a patient who fell and injured there arm, with a minor contusion on there head, would you immobolize?  Lets say that the patient is CAOX3, denies LOC, and does not complain of any neck/back pain.


----------



## DesertMedic66 (Jul 18, 2013)

For that patient, using my protocols we would not backboard.


----------



## STXmedic (Jul 18, 2013)

Again:





A good place for you to start would be to research Canadian C Spine Rules and NEXUS Criteria


----------



## Medic Tim (Jul 18, 2013)

chri1017 said:


> Out of curiosity where do most people draw the line with spinall immobolization and a minor head injury.  Say you had a patient who fell and injured there arm, with a minor contusion on there head, would you immobolize?  Lets say that the patient is CAOX3, denies LOC, and does not complain of any neck/back pain.



a fall from standing height with no deficits or midline pain is not an indication for smr. I wouldn't even need to go through our "clearance guideline" on this one as I do not suspect a c-spine injury.


----------



## TransportJockey (Jul 18, 2013)

Nope. Not gonna do it


----------



## Akulahawk (Jul 18, 2013)

chri1017 said:


> Out of curiosity where do most people draw the line with spinall immobolization and a minor head injury.  Say you had a patient who fell and injured there arm, with a minor contusion on there head, would you immobolize?  Lets say that the patient is CAOX3, denies LOC, and does not complain of any neck/back pain.


Arm injury from a fall with a minor head contusion... Hmm. No. No spine board for YOU! While I may have other concerns about a closed head injury, I have none about cervical spine injury.

My treatment plan would likely consist of treating/immobilizing the arm PRN, sitting patient in a position of comfort, transport to patient's hospital of choice, monitor for signs of developing CHI, including concussion.

What do I normally use? My protocols. Sometimes they suck... but if my patient doesn't need it and I can articulate why... 

What else do I use? Mechanism of Injury. No mechanism = no injury. Positive MOI = I look for injury where MOI tells me it's likely to be. No findings of injury = actual injury not likely. MOI correlates horribly with actual injury presence, but it correlates nicely when actual injury is present. In other words, MOI tells me where to look, nothing more than that.


----------



## hogdweeb (Jul 19, 2013)

unfortunately, my protocol says yes cause there is trauma to the head.... personally if i had my way, no.


----------



## mycrofft (Jul 19, 2013)

This help?






Follow your protocols.


----------



## CentralCalEMT (Jul 19, 2013)

In the absence of mid line pain in the spinal area, our protocols would not have us immobilize them.


----------



## Nickoliah123 (Jul 20, 2013)

i am in an intensive EMTB course right now and they would kill me if i didnt....as the other guy said though, if i had it my way i wouldnt


----------



## STXmedic (Jul 20, 2013)

Nickoliah123 said:


> i am in an intensive EMTB course right now and they would kill me if i didnt....as the other guy said though, if i had it my way i wouldnt



Is there such thing as an "intensive" EMT-B course? :lol:


----------



## Anjel (Jul 20, 2013)

PoeticInjustice said:


> Is there such thing as an "intensive" EMT-B course? :lol:



Duh. They teach intense stuff like......






And so I don't get in trouble...

I would not immobilize this patient. Only if the had neck or back pain or lost consciousness. Per protocol.


----------



## omak42 (Jul 20, 2013)

PoeticInjustice said:


> Is there such thing as an "intensive" EMT-B course? :lol:



Lol you beat me to it.  As far as the case....clinical judgment says no. Sadly a lot of protocols still say yes, luckily not mine.


----------



## ATFDFF (Jul 20, 2013)

One of my agencies would have me written up for backboarding this patient, the other would have me written up for NOT backboarding this patient.  

But if I had my way, this patient wouldn't be anywhere near a backboard.


----------



## LEB343 (Jul 22, 2013)

I got b*tched out by a nurse the other day for bringing a woman in not back boarded after being punched in the head. I stated pt consumed alcohol 6 hours prior to the event and he wanted her back boarded because alcohol was involved. Pt was not clinically intoxicated and did not complaint of neck or back pain. I don't get it...


----------



## rmabrey (Jul 22, 2013)

We use the Maine c-spine r/o. If you're familiar with it, it could be shortened extensively if it just said "board all patients".

That being said, no I would not board this patient and no I would not get in trouble for it. 

As soon as the new protocols are finished, we are ditching boards anyway.


----------



## Carlos Danger (Jul 22, 2013)

Medic Tim said:


> a fall from standing height with no deficits or midline pain is not an indication for smr. I wouldn't even need to go through our "clearance guideline" on this one as I do not suspect a c-spine injury.



You mean a "standing takedown" wouldn't be indicated?


----------



## MSDeltaFlt (Jul 22, 2013)

chri1017 said:


> Out of curiosity where do most people draw the line with spinall immobolization and a minor head injury.  Say you had a patient who fell and injured there arm, with a minor contusion on there head, would you immobolize?  Lets say that the patient is CAOX3, denies LOC, and does not complain of any neck/back pain.



The one and only reason I would use C-Spine restrictions with the above "complaints" would be if my hands on assessment showed something different than the initial complaints.

Speaking as someone who's had a broken neck.  The odds of someone moving their neck with an unstable cervical fracture are extremely remote.  Not impossible, but unlikely.  Why?  Because that @#$% hurts.


----------



## Medic Tim (Jul 22, 2013)

Halothane said:


> You mean a "standing takedown" wouldn't be indicated?



Standing takedown went out a few years ago. If there is an indication to board a pt and they are standing, we have them lay on the board.


----------



## mycrofft (Jul 22, 2013)

MSDeltaFlt said:


> The one and only reason I would use C-Spine restrictions with the above "complaints" would be if my hands on assessment showed something different than the initial complaints.
> 
> Speaking as someone who's had a broken neck.  The odds of someone moving their neck with an unstable cervical fracture are extremely remote.  Not impossible, but unlikely.  Why?  Because that @#$% hurts.



*What? Common sense and practical personal experience? Are you daft?! We can't have that here!!!*






Actually a good point. The initial and most urgent reason for prehospital cervical immobilization *was* (fill in the blank) :_____________________________________________.

Yes, because rescuers were killing people extricating them from MVA's in pre-safety features cars...or as they called it, "pulling folks out of wrecks".


----------



## Christopher (Jul 24, 2013)

LEB343 said:


> I got b*tched out by a nurse the other day for bringing a woman in not back boarded after being punched in the head. I stated pt consumed alcohol 6 hours prior to the event and he wanted her back boarded because alcohol was involved. Pt was not clinically intoxicated and did not complaint of neck or back pain. I don't get it...



I'd like to meet the dude who can punch a person's spine in two!

On second thought, no, no I wouldn't.


----------



## p1l0t (Jul 24, 2013)

Christopher said:


> I'd like to meet the dude who can punch a person's spine in two!
> 
> On second thought, no, no I wouldn't.



I have a friend who is (possibly was) a heavyweight boxer with two herniated discs in his neck. I've seen him do worse to others though. He is going to need surgery before (if) he ever fights again.


----------



## mycrofft (Jul 24, 2013)

Christopher said:


> I'd like to meet the dude who can punch a person's spine in two!
> 
> On second thought, no, no I wouldn't.



Chuck Norris


----------

