# Spinal Immobilization and Cardiac Arrests



## northernnhmedic (Dec 11, 2011)

Got called for a cardiac arrest at a local athletic club today, just outside of a room with treadmills.  We found the patient face down on the floor with no cpr in progress.  When I rolled him over, I noticed a fairly large abrasion arross his forehead.  A quick inspection of the area around him revealed no objects within 3-4 feet of him that he could have struck when he collapsed, as well as no evidence of him falling off any treadmills.  When we got to the hospital, they started questioning why we didnt immobilize him.  Were we right to not immobilize, or should we have boarded him?


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## usalsfyre (Dec 11, 2011)

Perhaps because well...he was dead and life threats (like CPR) take priority over an unproven intervention that will probably interrupt chest compressions?

This goes to show EMS doesn't have a lock on out of touch backwards providers.


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## mycrofft (Dec 11, 2011)

*He die?*

Just asking....
Hey, could have been a crime scene. Why didn't you walk backwards out of the scene and let the cops take are of him?


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## northernnhmedic (Dec 11, 2011)

mycrofft said:


> Just asking....
> Hey, could have been a crime scene. Why didn't you walk backwards out of the scene and let the cops take are of him?



It could have been.  It was unwitnessed, so it could have been alot of things.  And there were no signs of trauma aside from the abrasion


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## themooingdawg (Dec 11, 2011)

i don't think cspine at that time prob mattered if pt is in a full arrest


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## medic417 (Dec 11, 2011)

Backboard provides firm surface for CPR.
C-collar helps keep airway aligned so tube is less likely to be displaced. 
Note main reason for use in cardiac arrest is not to protect spine.   

More important question is why are you transporting a code?


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## Epi-do (Dec 11, 2011)

Placing the patient on a backboard to facilitate chest compressions is a good thing.  That being said, any spinal injury he may have had isn't going to matter if he is dead.  (And no one can prove it works anyway.)  No, I wouldn't have c-spined this patient.

medic417, while we have a protocol that allows us to work an arrest for 30 minutes and walk away without transporting if there is no ROSC, in a situation like this, where the patient is in the middle of a public place, we would have transported as well.  I know it doesn't make things right, but the thought is that we "can't" leave the dead body in the middle of the business like that.  It makes for bad PR, which makes the higher ups unhappy when it hits the news, and we all know which direction crap rolls.


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## Bosco836 (Dec 11, 2011)

northernnhmedic said:


> Got called for a cardiac arrest at a local athletic club today, just outside of a room with treadmills.  We found the patient face down on the floor with no cpr in progress.  When I rolled him over, I noticed a fairly large abrasion arross his forehead.  A quick inspection of the area around him revealed no objects within 3-4 feet of him that he could have struck when he collapsed, as well as no evidence of him falling off any treadmills.  When we got to the hospital, they started questioning why we didnt immobilize him.  Were we right to not immobilize, or should we have boarded him?




Although the old adage of "life over limb, life over cord" has some truth to it, our protocols over here would dictate that this person should be boarded baring any unusual circumstances (due to the fact that it remains unclear exactly what happened, leaving the possibility for a spinal injury - further compounded by the fact that the he had an abrasion on his head, and is obviously not awake to identify any sort of head/neck/back pain or provide information on how he ended up on the floor). 

Arguably, given the fact that this individual likely fell from a standing height, the possibility of a spinal injury is fairly remote; however, can not be exclusively ruled out...and thus the decision (at least by our protocols) to ere on the side of caution.

Further to the above, as others have suggested, not only are there advantages re: improving the quality of CPR, but spinal immobilization (in this case) helps to deter any accusations of negligence in the rare event that this individual happens to survive and ends up suffering from some sort of spinal injury.  

With all of that said though - 20/20 hindsight is a wonderful tool for reflection..but in the real world, we are sometimes forced to make split second decisions.  Life isn't always textbook and sometimes situations don't allow for protocols to be followed, or require the provider to exercise reasonably sound clinical judgment.


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## firecoins (Dec 11, 2011)

I would have had the pt on a board for CPR. As long as the collar doesn't restrict the airway, it goes on.

Our concern is life over crime scenes.


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## mycrofft (Dec 12, 2011)

*Food for thread...anyone here know a case...*

when, absent bone disorder or advanced age, anyone has injured their spine requiring immobilization (excluding coxyx, or do we board those too?) "from a standing height" (i.e., standing up, they fall to the floor)? Anyone? For real?


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## jpmedic21 (Dec 12, 2011)

I had a 80 something female fall out of bed at the nh and fracture c4 and c5. Does that count?


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## Smash (Dec 12, 2011)

jpmedic21 said:


> I had a 80 something female fall out of bed at the nh and fracture c4 and c5. Does that count?





mycrofft said:


> when, absent bone disorder or advanced age,



No, I haven't.


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## mycrofft (Dec 13, 2011)

*Yes 80 y/o counts as advanced age.*

I've seen people hurt who were running, or suspended then dropped six feet; one of them fractured his femur running in the dark on a black-painted stanchion, but not just falling down.

It's really a trick question, based on the handy but really imprecise phrase "from standing". 

I've seen people pinch a cervical nerve while lying down (no fall) that the distal arm was agonizing or in paresthesia. No fall at all, but cervical immobilization helped the discomfort.


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## Emtpbill (Dec 15, 2011)

If there is no mechanism they don't get a collar and board, although I agree with using the board and collar with keeping the airway lined up, everything is secondary to getting the heart going.


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## DrParasite (Dec 15, 2011)

medic417 said:


> Backboard provides firm surface for CPR.
> C-collar helps keep airway aligned so tube is less likely to be displaced.
> Note main reason for use in cardiac arrest is not to protect spine.


inclined to agree on both points





medic417 said:


> More important question is why are you transporting a code?


because my field supervisor, clinical coordinator, operations coordinator, medical director, and ER attending all want me to.  

unless there are signs of obvious death (cold, rigor, lividity, etc) beforehand, once we start CPR, most of the time we don't stop until we drop the patient off in the ER.


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## MSDeltaFlt (Dec 16, 2011)

northernnhmedic said:


> Got called for a cardiac arrest at a local athletic club today, just outside of a room with treadmills.  We found the patient face down on the floor with no cpr in progress.  When I rolled him over, I noticed a fairly large abrasion arross his forehead.  A quick inspection of the area around him revealed no objects within 3-4 feet of him that he could have struck when he collapsed, as well as no evidence of him falling off any treadmills.  When we got to the hospital, they started questioning why we didnt immobilize him.  Were we right to not immobilize, or should we have boarded him?



1.  How long was it from time of 911 call to your arrival on scene?

2.  Abrasion to forehead or hematoma?

3.  Asystole on monitor?


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## northernnhmedic (Dec 16, 2011)

MSDeltaFlt said:


> 1.  How long was it from time of 911 call to your arrival on scene?
> 
> 2.  Abrasion to forehead or hematoma?
> 
> 3.  Asystole on monitor?



1.  Under 3 minutes.  The state communications center was still EMD'ing the call when we pulled up on scene.  We dont know how long he was down since no one witnessed him go down, and he was found by a worker at the gym found him.

2.  It was an abrasion, consistent with rug burn.

3.  Asystole from the get-go.  Normally this is something ill either call right off the bat, or work for 20 minutes and call. But this was in a public place in a small town, it was easier for us to transport than to leave a body in public, short of signs of irreversible death.


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## mycrofft (Dec 17, 2011)

*Rug burn on the forehead?*

Check his knees?


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## tssemt2010 (Dec 17, 2011)

just ran an arrest about 20 minutes ago, no c-collar, just a scoop stretcher and moved them straight to the regular stretcher.


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## Handsome Robb (Dec 17, 2011)

mycrofft said:


> Check his knees?



How did I know someone was going to go there? :rofl:

I don't think c-spine is truly indicated here. Get ROSC then worry about it.

I don't remember who said it but if you use the c-collar to prevent manipulation of an advanced airway as well as using a LSB for a hard surface/pt movement in a situation like this you're 3/4 of the way to full spinal motion restriction for this pt if you do get ROSC.


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## usafmedic45 (Dec 17, 2011)

> short of signs of irreversible death.



In my book, short of lightning strike or massive hypothermia, asystole is a sign of irreversible death.


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## mycrofft (Dec 17, 2011)

*Yeah, but the public can't see asystole.*

Just tuck the blanket in and put an O2 mask on him, load 'em, and run away. Tell bystanders he's just sleeping now.


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## usafmedic45 (Dec 17, 2011)

mycrofft said:


> Just tuck the blanket in and put an O2 mask on him, load 'em, and run away. Tell bystanders he's just sleeping now.



I have no problem leaving the body where it is.  :censored::censored::censored::censored: happens.  People just need to learn to be less whiny when it does.


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## mycrofft (Dec 17, 2011)

*But if we don't remove the remains, who they gonna call?*

Hmmmmmmm?


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## Sam Adams (Dec 18, 2011)

northernnhmedic said:


> Got called for a cardiac arrest at a local athletic club today, just outside of a room with treadmills.  We found the patient face down on the floor with no cpr in progress.  When I rolled him over, I noticed a fairly large abrasion arross his forehead.  A quick inspection of the area around him revealed no objects within 3-4 feet of him that he could have struck when he collapsed, as well as no evidence of him falling off any treadmills.  When we got to the hospital, they started questioning why we didnt immobilize him.  Were we right to not immobilize, or should we have boarded him?



Confucious say "a dead man complains not, about being paralyzed"


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## usafmedic45 (Dec 18, 2011)

mycrofft said:


> Hmmmmmmm?



Coroner or medical examiner.


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## mycrofft (Dec 18, 2011)

*Spoilsport*

Then they go all LE on you're butt. I hate it when that happens.


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## usafmedic45 (Dec 18, 2011)

> Then they go all LE on you're butt. I hate it when that happens.



How so?


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## Medic419 (Dec 18, 2011)

Anyone put there using a C-collar to assist in head positioning prior to intubation?


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## usalsfyre (Dec 18, 2011)

Medic419 said:


> Anyone put there using a C-collar to assist in head positioning prior to intubation?



Considering it puts the head in the wrong position and seriously limits jaw mobility, I'd say this is a bad idea.


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## Medic419 (Dec 18, 2011)

usalsfyre said:


> Considering it puts the head in the wrong position and seriously limits jaw mobility, I'd say this is a bad idea.



Was kinda my thought as well. I had someone trying to sell the idea to me last week. My thought here would be to possibly use it prior to moving a patient to prevent head movement and a possible loss of a good tube.


thanks for the reply.

Dan


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## Medic Tim (Dec 18, 2011)

I use a collar post tube


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## Handsome Robb (Dec 18, 2011)

Medic419 said:


> Was kinda my thought as well. I had someone trying to sell the idea to me last week. My thought here would be to possibly use it prior to moving a patient to prevent head movement and a possible loss of a good tube.
> 
> 
> thanks for the reply.
> ...



It's pretty standard to use a collar *after*you place the tube for the exact reason you mentioned.

I say standard but I'm sure someone will disagree so I'll edit my statement: in the system I work in it is common practice to use a collar along with proper securing to help maintain a good tube post intubation.


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