Backboarding question.

emtfarva

emtfarva

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Lets say you were called on a response to a doctors' office for a Pt that fell earilier in the day. This Pt was prone to falls and syncope. The Pt was amb and went to his Dr's office for a checkup. (This was a scheduled appt.) The Dr called to have Pt evalutated at local ER for R/O head bleed due to coumadin tx. The doc reported that the Pt had no neuro defects. Pt, non-english speaking, is c/o neck pain. Would you collar and board this Pt?


Fyi: the Pt didn't get boarded and had a c2 fx from the fall eariler. When transported latter to a trauma center Pt still had no neruo defects.

And don't tell me that I should have boarded the Pt. I want to know in that case would you have boarded the Pt without knowing about the fx.
 
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How did the pt fall? Was there any ALOC? How high was the fall? Falling from a standing position and driving to the clinic for a scheduled appt and c/o neck pain will get a collar as long as there was no LOC.

Also, what exactly was broken on the neck? Was it a vetebral body or a spinus process? Was the spinal canal compromised?

I only ask because of my neck Fx. I had a Hangman's Fx (C2 and Odontoid) involving the C2 vetebral body. I also had a C7 lateral mass Fx. The lateral Fx didn't necessarily need a Collr, but the vetebral body fx did.
 
The great backboard debate. In my opinion anyone c/o neck pain post fall gets backboarded regardless of how long ago it was. Is it probably nothing? yes it is probably absolutely nothing, but on the off chance it is something my buttocks is protected. On the other hand just because someone fell doesn't mean they need to be boarded, if they have no complaints, no LOC post fall, and physical exam finds nothing, then they don't necessarily buy a backboard. Ultimately its up to you and what treatment you feel comfortable with.
 
MSDeltaFlt said:
How did the pt fall? Was there any ALOC? How high was the fall? Falling from a standing position and driving to the clinic for a scheduled appt and c/o neck pain will get a collar as long as there was no LOC.

Also, what exactly was broken on the neck? Was it a vetebral body or a spinus process? Was the spinal canal compromised?

I only ask because of my neck Fx. I had a Hangman's Fx (C2 and Odontoid) involving the C2 vetebral body. I also had a C7 lateral mass Fx. The lateral Fx didn't necessarily need a Collr, but the vetebral body fx did.
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The Pt fell prob due to Syncope. I want to say the Pt has chronic A-fib. And I am not sure about what type of Fx he had. We didn't transport him to Boston. Yes he had +LOC. With That Info would you still board him. oh, it was a standing fall and he hit his head on something. ( that is how he broke his neck. he also doesn't remember how he fell.)
 
If I got there and the patient had neck pain from a fall, no matter how long ago it was, I would more then likely collar and backboard. I rather over treat then under treat. As sirshockalot already stated, if it ends up being nothing then oh well, but at least I saved my butt in case it was something.
 
Firstly Backboards, AKA spineboards are an extrication device, not a transport tool.

Lets say you were called on a response to a doctors' office for a Pt that fell earilier in the day. This Pt was prone to falls and syncope. The Pt was amb and went to his Dr's office for a checkup. (This was a scheduled appt.) The Dr called to have Pt evalutated at local ER for R/O head bleed due to coumadin tx. The doc reported that the Pt had no neuro defects. Pt, non-english speaking, is c/o neck pain. Would you collar and board this Pt?
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is this not enough to say lets be carful? even with no neuro defecits. The fact that the pt is
non-english speaking
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with indications to cervical pain is enough to indicate a callar for precaution.

emtfarva, let me ask you a question that is along similar lines. You are called to a motor vehicle accident. On arrival you see it was a High Speed single vehicle rollover. The patient is & has been walking around the scene. Questioning of bystanders indicate the accident occured 30-40 mins prior to your arrival. Would you collar this patient?
 
You responded to a facility with a doctor on staff. Did the doctor clear his c-spine? Did you ask the sending physician what if any precautions the patient warranted? This patient was already in the care of a licensed physician, If the doctor was comfortable transporting this patient without a board, then that is the doctors decision. The patient clearly ambulated to his appointment and has no deficits.
 
boingo said:
You responded to a facility with a doctor on staff. Did the doctor clear his c-spine? Did you ask the sending physician what if any precautions the patient warranted? This patient was already in the care of a licensed physician, If the doctor was comfortable transporting this patient without a board, then that is the doctors decision. The patient clearly ambulated to his appointment and has no deficits.
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Ooooh, I'd be a little leary,some of the Med center Doc's I've delt with were pretty weak with trauma assessment. Infact some of them border on stupidity.:glare: Pluse with language barrier ( some times pt. AND Doc both ), he or she may have not been able to get a good hx.:sad:
 
As much as I question the entire notion of c-spining everyone just because they suffered a a trauma (do we splint arms for no other reason than a patient fell on it? Do you call EMS every time you fall?), I have no choice but to agree with c-spineing patients with midline back/neck pain/tenderness and neurodeficits.

As far as the high speed roll over, 30-40 minutes post accident with the patient self-extricating and ambulating since the accident? As much as I'd like to say that it would depend on my assessment, I'd rather be a cook book practitioner than sit around debating the merits of spinal immobilization with people who can't see past their 110 hour advanced first aid course while throwing out platitudes about how "it doesn't hurt, why not do it?."
 
MSDeltaFlt said:
How did the pt fall? Was there any ALOC? How high was the fall? Falling from a standing position and driving to the clinic for a scheduled appt and c/o neck pain will get a collar as long as there was no LOC.

Also, what exactly was broken on the neck? Was it a vetebral body or a spinus process? Was the spinal canal compromised?

I only ask because of my neck Fx. I had a Hangman's Fx (C2 and Odontoid) involving the C2 vetebral body. I also had a C7 lateral mass Fx. The lateral Fx didn't necessarily need a Collr, but the vetebral body fx did.
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I would have collared this patient if for nothing else just as a reminder for them to keep their head still. I know this is atypical but when I broke my neck C3 and C4 with C4 being completly shattered I had no pain or point tenderness or neurological defecits just the feeling that something was not right. The medics on the call wanted to clear me due to the fact that I met their criteria to clear in the field. Even the e.R. doctor was willing to clear me until after the X-Rays and C.T. Scan. After those he would not let me off the collar and board until a more stable collar was in place. Remember just because the typical symptoms are not there doesn't mean nothing is going on.
 
I can see the point that the studies are showing given the fact that the majority of injury is done during the accident. It is even probable that a patients neck muscles are strong enough to provide enough stability to prevent further injury during transport. However in my case I had more of a peace of mind just knowing that precautions were in place.
 
Someone here said it perfectly "midline neck pain". That right there IMO makes the board justified. In Wyoming, I as a medic can "clear" a patients C-spine on scene per our medical protocols. That being said, I rarely do that for fear of litigation (i dont have x-ray vision). I do clear if I have a very good feeling that it is NOT a spinal injury but remember, Walks like a duck,quacks like a duck, swims like a duck, IT IS PROBABLY A DUCK.

It is always safer to board than not to, HOWEVER (there is always a however with me :rolleyes:) the caveat is that placing a person on a board for longer than 1 hour can start to cause other problems.

In our system, several years ago I fell and broke up my t-12/l-1 area. I was backboarded on scene and taken to the hospital. I stayed backboarded for over 9 hours. It cause some rather severe skin break down and some masking of symptoms that led to me having other complaints associated with muscle spasm.

This ended up being a waste of time and money for me.

In the particular question, If the patient has midline point tenderness ANYWHERE along the spine, BACKBOARD. And as was already pointed out, the c-2 area CAN be rather well supported by neck muscles. Was this person an office jockey or a laborer? Laborer may have pretty developed neck muscles.

Time since fall does not matter. 95% of the time nothing will be wrong. But that other 5%, it pays to be careful.

Wy Medic
 
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boingo said:
You responded to a facility with a doctor on staff. Did the doctor clear his c-spine? Did you ask the sending physician what if any precautions the patient warranted? This patient was already in the care of a licensed physician, If the doctor was comfortable transporting this patient without a board, then that is the doctors decision. The patient clearly ambulated to his appointment and has no deficits.
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Well what kind of doctor was it? Was it an optometrist or podiatrist clearing C-Spine? They all went through medical school, but they don't necessairly see enough spinal injuries to be up to snuff with their assesments.

He could have had no neural deficts now, but moving with a fractured C2... Couldn't fragments shift around and potentially damage the cord or intervertebral fibrocartilage or something? After all he did have NECK pain.

The doctor turned over care to the responding EMTs. Therefore they're responsible for the care. Personally, I would have backboarded due to the c/o neck pain.
 
emtfarva said:
The Pt fell prob due to Syncope. I want to say the Pt has chronic A-fib. And I am not sure about what type of Fx he had. We didn't transport him to Boston. Yes he had +LOC. With That Info would you still board him. oh, it was a standing fall and he hit his head on something. ( that is how he broke his neck. he also doesn't remember how he fell.)
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Yes, full C-Spine precautions (or restrictions) would be performed on this guy if he were my pt. Notice I didn't say "immobilization". That comes with halo placement. But, yes. I would go the whole 9 yards on him.
 
Wyoming Medic said:
Someone here said it perfectly "midline neck pain". That right there IMO makes the board justified.
In the particular question, If the patient has midline point tenderness ANYWHERE along the spine, BACKBOARD. And as was already pointed out, the c-2 area CAN be rather well supported by neck muscles. Was this person an office jockey or a laborer? Laborer may have pretty developed neck muscles.

Time since fall does not matter. 95% of the time nothing will be wrong. But that other 5%, it pays to be careful.

Wy Medic
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Don't forget that if the pt is the better or worse for recreational chemcials or alcohol ingestion, their perception of pain can be skewed. Feeling no pain may have nothing to do with the seriousness of the injuries in those cases.
 
C-spine precautions

I will be the first to backboard a patient with the complaint of neck and or back pain, and MOI. I do think part of the problem is how long patients are on these boards when they arrive to the ED, for the most part most folks that have worked in an ED have never worked in the field or have been a patient themselves.
 
BossyCow said:
Don't forget that if the pt is the better or worse for recreational chemcials or alcohol ingestion, their perception of pain can be skewed. Feeling no pain may have nothing to do with the seriousness of the injuries in those cases.
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Very good point.

Wy medic
 
To board or not to board

I would much rather err on the side of caution and have it be unneccesary. In this situation, I would go ahead and collar and board the patient. There is a hx of fall, and c/o neck pain. That is enough for me.
 
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