Any reason C-Spine would be contraindicated?

[Anonymous]

Patient involved in MVA, multiple head, facial and leg injuries/fractures. GCS 3, Inadequate ventilations.

Anyway this may be a dumb question but in a scenario such as this or something similar is there ever a good reason not to c-spine?

 

[Clare]

Patient involved in MVA, multiple head, facial and leg injuries/fractures. GCS 3, Inadequate ventilations.

Anyway this may be a dumb question but in a scenario such as this or something similar is there ever a good reason not to c-spine?

Yes, if it prevents you gaining adequate control of the airway. A good, patent airway is always much more important than the chance of a cervical spine injury.

If the patient fights the cervical collar (not that I think somebody with a GCS of 3 would be doing much fighting) then it is OK to remove it as well, if they are moving around because they are uncomfortable then its better to just remove it.

 

[RocketMedic]

Other patients with inadequate resources, or perhaps odd positioning/posturing.

The prognosis of this patient is already poor, but many of us would be crucified by our employers/medical directors if we didn't C-spine/backboard this patient. Voodoo medicine and all that.

 

[Clare]

Kinda related to what I said before; if the patient is in respiratory or cardiac arrest then they need to be flat on their back and receiving CPR and its obviously impossible to remove them from the car with adequate cervical spine precautions, however having said that if they need CPR in the setting of road crash (i.e traumatic arrest) then the prognosis for survival is extremely low and CPR is likely to be quickly discontinued as it is clinically futile to try and resuscitate the patient anyway.

 

[leoemt]

Patient involved in MVA, multiple head, facial and leg injuries/fractures. GCS 3, Inadequate ventilations.

Anyway this may be a dumb question but in a scenario such as this or something similar is there ever a good reason not to c-spine?

Yeah - patient is unresponsive. Most likely with a score of 3 they are going to need CPR either now or very soon. CPR takes precedence over C-Spine. Life before limb.

Your going to intubate so you will need ALS. Facial injuries would most likely prevent you from obtaining a good seal with a BVM.

MOI is significant to cause that much injury you will have more to worry about than c-spine.

Other agencies may c-spine but we wouldn't - assuming this is how we found the patient.