# infant



## Ediron (Jan 4, 2010)

how would you immobilize an infant??



and if a patient has a cervical injury below 5th and above the 3rd 
vertebrae he loses the ability to breath correct?

I also need help with dislocations

do you first:

stabilize
asses CMS
splint above and below
and then immobilize???

thanx


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## exodus (Jan 4, 2010)

Ediron said:


> how would you immobilize an infant??
> 
> 
> 
> ...



Breathe for the pt.... hopefully intubate if you can, but breathe for them with a BVM..


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## paccookie (Jan 4, 2010)

Ediron said:


> how would you immobilize an infant??
> 
> and if a patient has a cervical injury below 5th and above the 3rd
> vertebrae he loses the ability to breath correct?
> ...



If you don't have the correct sized c-collar, you can use a towel roll.  If you don't have a pediatric backboard, put a folded towel under the infant's shoulders and secure the child to the backboard as you would an adult (you might have to use tape if your straps don't fit the child.  

My understanding of cervical fractures is that anything above c3 requires respiratory support as the pt will not be able to breathe on his own.  A fracture between c3-5 will likely require some respiratory support, but the pt should still breathe on his own.  He won't be able to use intercostal muscles to assist respirations and will likely breathe like an infant (belly breathing) as he will only be able to use his diaphragm to expand the lungs.  Respirations will likely be shallow and lack sufficient tidal volume as the lungs are not fully expanding.  (someone please correct me if i'm wrong)

As for dislocations, they should be treated like a fracture.  Assess distal PMS, splint as necessary and transport immediately, emergency if no distal PMS is present.  Attempts to reduce a dislocation in the field may lead to further, more serious injury.  The pt will likely require sedation prior to reduction, which will likely be a lot more than most EMS units carry on the truck.  Plus, an x-ray should be done prior to reduction to gauge the extent of the injury.  I was taught that a knee dislocation is the only thing that an attempt (that's ONE attempt) at field reduction may be used.  I have had one pt in 2 1/2 years that has had a knee dislocation.  We attempted reduction once, pt c/o pain and reduction was abandoned.  X-rays showed that the pt had a tibial plateau fx along with the dislocation.


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## WTEngel (Jan 4, 2010)

Alright, for testing purposes, I guess you should be concerned with the location of the fracture. For real world purposes, you will have no idea if there is a fracture, or where it is located...all you will know is signs of neurological deficit, and treat the treatable. 

Immobilizing an infant is done the same as an adult, with an appropriate sized c collar, and the addition of a roll under the shoulders to assist in maintaining an open airway. I guess if you for some reason did not have a collar in the correct size, then you do the best with what you have...a towel roll could be used, but it is not ideal.

Splinting for dislocations is same as fractures, as the earlier poster mentioned. Assess PMS first, splint appropriatey, assess PMS again, and then basically continuously assess PMS, and make sure you document it. Who knows how far down the line someone may lose PMS in an extremity, and the blame may come back to you if you did not chart well. Pain management as allowed in your protocol is important also. 

That is interesting about the knee dislocation. I have never heard that about field reduction specific only to knee injuries. The old protocols I used to work under had a provision for one attempted field reduction, if PMS was not intact distal to the injury. After one attempt, no more manipulation was allowed without further orders. Protocols are like snowflakes though, no two are ever the same, and some doctors make changes and additions frequently to keep up with the trends...


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## Ediron (Jan 4, 2010)

*thanx*

everyone


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## 18G (Jan 4, 2010)

Commercial pedi boards work best for immobilizing kids. A KED board also works well for immobilizing infants and children. If the infant is in a car seat, immobilize them in the car seat if they are stable. Pad the car seat and towel rolls around the head. 

Dislocations are treated the same as fractures. No way to tell apart in the field.


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## Seaglass (Jan 4, 2010)

paccookie said:


> My understanding of cervical fractures is that anything above c3 requires respiratory support as the pt will not be able to breathe on his own.  A fracture between c3-5 will likely require some respiratory support, but the pt should still breathe on his own.  He won't be able to use intercostal muscles to assist respirations and will likely breathe like an infant (belly breathing) as he will only be able to use his diaphragm to expand the lungs.  Respirations will likely be shallow and lack sufficient tidal volume as the lungs are not fully expanding.  (someone please correct me if i'm wrong)



I've yet to actually deal with a spinal fracture requiring respiratory support, but my understanding is that an injury to C3-5 is likely to compromise the diaphragm ("C3, 4, 5 keep the diaphragm alive"--the phrenic nerves) although it will likely retain some function if the injury is restricted to C5, or if only one of the two phrenic nerves is injured. (I'd also like a correction if I'm wrong, which I may well be...)


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## 18G (Jan 4, 2010)

"C3, 4, 5 keep the diaphragm alive"... I like that! never heard that before.


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## Jeffrey_169 (Jan 9, 2010)

There are a few ways a splint can be made for an infant, and they work on just about everyone. In the case of the infant, a car seat works well (if one is available) in combination with rolled towels under the shoulders as some others have stated. 

Another way is one I learned in the military. I do not know if your service carries one, but I carry several in my truck. I take a Sam Splint (or a coated splint) and make a little indent for the chin, and I contour it to the patient. It is rigid enough in a pinch, yet flexible when it needs to be. 

As for splinting, well you want to check DMS and circulation before and after you splint.


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