C spine, backboard, and stabbing

I'm still a little doubtful on prone. Are you suggesting that we might bag someone lying on their stomach? Or the medic might intubate them like that?
 
Brandon Oto said:
I'm still a little doubtful on prone. Are you suggesting that we might bag someone lying on their stomach? Or the medic might intubate them like that?
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I've seen medics intubate someone who is prone, and I've used a combitube on someone who is in that position as well.
 
Brandon Oto said:
I'm still a little doubtful on prone. Are you suggesting that we might bag someone lying on their stomach? Or the medic might intubate them like that?
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Common sense would dictate obviously not
 
Well, you're kinda of stuck between a rock and a hard place then, because you aren't gonna be pulling that knife out until the patient crashes. Not everything is going to be "ZOMG if I don't do it exactly by the book the patient will die!" Patients are pretty good at not reading the book.
 
This thread is getting kinda weird... so... IMAO...

DO NOT TAKE OUT THE KNIFE!!!

Everyone here is going on the assumption that the pt. is unconscious and in need of airway management and assistacne in breathing... so... NPA, OPA, ETT, and any other airway device can be inserted with a pt. in a lateral postition (even if it ain't what they taught in EMT class). Do we want the pt. supine? Heck no!!! Do we want them prone? Not the best method for manageing airway and breathing... so lateral will do just fine... but, wait, what about their spinal issues? Last time I checked, they are called the ABCs because they come FIRST! These are life threatening issues. A POSSIBLE lumbar spinal issue is not as important to me as AB... and C (something that could be a huge issue if you remove the knife). Do I care more about if the spinal cord is cut by the knife... or if the knife has hit one of those vital (blood rich) organs? On top of that, if the spinal cord is already damaged, all I can do is stabilize the impailed object so as to reduce the likelyhood of further life-threatening damage to vital organs/blood vessels and further spinal damage (what could you cut in the spine if you remove it?). Therefore, the best method, IMHO, to secure that knife and "do no further harm" is to place the pt. prone if they were conscious and maintaining their own airway and breathing fine... because I want to minimize movement (hard to do lateral in a moving ambo)... but you do what you have to do and lateral may be the best bet if you need to manage the As and Bs in an unconscious pt. However, since we are all assuming unconsciousness... lets get real... why is he unconscious? Blood loss make sense to you? Chances are that the knife hit a vital organ and NO AMOUNT of care is gonna matter, so you do the best you can to maintain the ABCs... spinal issues are in the back of your mind... and chances of survival are already low... so it is a "lesser of two evils" situation...
 
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Brandon Oto said:
I'm still a little doubtful on prone. Are you suggesting that we might bag someone lying on their stomach? Or the medic might intubate them like that?
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Okay, who said their not breathing or needs to be intubated, etc..? As stated I have intubated prone patients, lateral side etc... Get experienced and it's amazing what you can do.

There is NO mention in any curriculum or trauma courses of ever removing an object (unless it is is the facial cheek that is obstructing an airway)

Let's use the KISSS method (Keep It Short Simple, Stupid)
Second, if they are in traumatic arrest, I probably would not be working them...

R/r 911
 
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Kinda freaky someone is confident in removing the knife! The golden rule is always to NEVER remove an impaled object unless it is causing airway compromise.

If if lacerated going in... its going to lacerate coming back out!... so in effect it would kinda like you stabbing the patient a second time... think of it that way.

I agree lateral or prone.. how else are you going to transport them? Several other factors would come into play with that decision but you obviously cant put them on their back with a knife stuck in it.
 
hyrisk said:
Okay need to clarify and confirm my friends. I got my money on this. There's. Pt with a knife to the smack center of their lumbar. The knife on the back is waving to you hello. What you going to do. C spine, backboard, or what
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My decision is based on how I found the patient and the patient's status. In general, I'd prefer to stablilize with bulky dressings and tape, transport in a Left lateral position. I might use a spineboard for packaging/transfer purposes, but a flat or scoop stretcher works good for that too. Of course, distal neuros would be checked before & after each transfer...

If I'm concerned at all about a spinal cord injury, I'm going to put my patient in the position that MINIMIZES any movement in the area where the knife is. That position will also be one that's comfortable for the patient. It's no use if your patient is constantly wiggling to find a position of comfort and can't because you've got them restrained in a position that causes them more pain/discomfort. If had a vacuum splint backboard setup, I'd use that...

That knife is staying in place. If it's in the L-Spine area, it's not compromising the patient's airway.
 
This is similar to a question on my NREMT. That question was "how to manage the airway on an uncon. pt with a knife in the back" The options were 1)bulky dressing to secure the knife and place pt. on side 2)bulky dressing to secure knife and leave pt. prone 3)pull knife out and place pt. supine 4)pull knife out and start CPR or something crazy like that.
I went with 1. Not sure if it was correct.
 
traumamama said:
not just spinal inj but also internal. how far did that knife go in?
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Considering that it's below L1, depending on the size of the knife there probably isn't any spinal damage because of the caudate equina. The question is what other structures was damaged, and potentially will be damaged, by blindly pulling the knife out.
 
Ella~Emt15136 said:
This is similar to a question on my NREMT. That question was "how to manage the airway on an uncon. pt with a knife in the back" The options were 1)bulky dressing to secure the knife and place pt. on side 2)bulky dressing to secure knife and leave pt. prone 3)pull knife out and place pt. supine 4)pull knife out and start CPR or something crazy like that.
I went with 1. Not sure if it was correct.
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The most appropriate answer would be to place in prone position as one easily manage an airway in a lateral position.

The second close answer would be place in a prone position.

R/r 911
 
Ridryder911 said:
The most appropriate answer would be to place in prone position as one easily manage an airway in a lateral position.

The second close answer would be place in a prone position.

R/r 911
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He means most appropriate would be lateral
 
I'd go with stabilize and lateral positioning as well.

There are only a few reasons for removing an impaled object. Necessary to maintain the airway, necessary to do CPR, or necessary for pt. safety.
 
AlphaButch said:
I'd go with stabilize and lateral positioning as well.

There are only a few reasons for removing an impaled object. Necessary to maintain the airway, necessary to do CPR, or necessary for pt. safety.
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If one has to do CPR, then it is time to call for notify medical control to stop resucitation efforts.

R/r 911
 
Perhaps calling in for a cease would be appropriate, and I personally would advise med control in any case. It would really depend on the totality of the circumstances. I was merely informing the written standards for when an impaled object to the back may be removed as per my training.

No CPR = DRT, Remove object + CPR = Possible DRT, Possible spinal injury, Possible recovery. If it were me on the floor, I'd at least want you to give the AED a shot before writing me off.
 
Mountain Res-Q said:
DO NOT TAKE OUT THE KNIFE!!!
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Thank you! Removing an impaled object is always a bad idea unless its blocking the airway. I have no idea why some are advocating removing the knife. Reminds me of a horror story a doctor told me-- a moronic surgical resident thought it would be a good idea to take a screwdriver out of a patient's head... ;)
 
Id transport the pt in the lateral postion and stabilize the knife,(was never taught to remove an impaled object not sure what they teach you in the us.) and stop any major bleeding, put and NRB on and get a line going and make tracks.
 
1st post

Kind of hard to believe that there are people here trying to justify pulling the knife straight away.

With the group here, if CPR was required and the blade was compromising it, I'm calling MD for orders to stop CPR, and if for whatever reason I dont do that, I'm sure calling MD to get orders to pull that knife in order to continue.

In this case, transport A & O pt lateral or prone, take extra precautions to stabilize the blade to try to keep it from moving around during transport.
 
ah2388 said:
Kind of hard to believe that there are people here trying to justify pulling the knife straight away.

With the group here, if CPR was required and the blade was compromising it, I'm calling MD for orders to stop CPR, and if for whatever reason I dont do that, I'm sure calling MD to get orders to pull that knife in order to continue.

In this case, transport A & O pt lateral or prone, take extra precautions to stabilize the blade to try to keep it from moving around during transport.
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That's really all there is to it. Other than complications with performing CPR, this is a straightforward scenario per training even at the basic level.
 
ah2388 said:
Kind of hard to believe that there are people here trying to justify pulling the knife straight away.

With the group here, if CPR was required and the blade was compromising it, I'm calling MD for orders to stop CPR, and if for whatever reason I dont do that, I'm sure calling MD to get orders to pull that knife in order to continue.

In this case, transport A & O pt lateral or prone, take extra precautions to stabilize the blade to try to keep it from moving around during transport.
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Once again (as we are revisting this crazy thread)... If CPR is needed with a knife inpalement, the reason for the arrest is likely a result of the knife... THEY ARE DEAD!!! Unless they were stabbed and coded in a Trauma Center they do not stand a chance... in which case, we still do not remove the knife... the investigator and coroner will be pretty pissed if you tamper with the evidence...

Need CPR... DEAD... Leave Knife

No need for CPR... Remove Knife... DEAD

Patient Stable... Leave Knife in... Bulk Dressing... Place patient in a postition of comfort that does not have the potential to cause more damage... IVs... mointor... supportive care... transport very gently... and for Gods Sake... DO NOT REMOVE THE KNIFE unless you want to be the one the invesigators, the coroner, and State EMS are investigating... (any meaningful treatment that has a chance of saving an unstable patient can be done with a patient not in a suppine position!)
 
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