C-spine/packaging and CPR and ROSC

[AlwaysLearning]

Hey sorry if this has been discussed already but searching the topic was near impossible because every search with C-spine in it returns all the info on C-spine's latest, wasn't what I was looking for.

I'm a new medic so I get this is probably a super simple answer and I feel dumb so sorry but I still have to ask.

So you're doing CPR on a patient. If you suspect injury and need to C-spine when should you do it? It will interfere with intubating so have someone manually hold it until after intubating? Or put it on, take it off to intubate, put it back on? And if you don't suspect injury but get ROSC and the patient is still unresponsive and you're packaging them for transport should you C-spine them just for packaging purposes to help hold the head steady?

Thanks.

 

[NomadicMedic]

I think use of a c-collar in a suspected traumatic injury patient is probably not a bad idea. That c-collar can also help prevent neck flexion which may help to keep your endotracheal tube in place. It's written "consider c-collar use after intubation" in my protocols.

Moving a CPR patient on a backboard is also probably a good idea if you're doing manual compressions.

Intubating with a collar is a pain in the rump. It can be done, but it certainly not as easy as being able to manipulate the patient's head and neck as normal. I've always loosened the collar, had someone hold In line stabilization and then intubated. This is where VL makes a lot of sense.

 

[Handsome Robb]

This might sound brash but if someone is in cardiac arrest and you suspect a c-spine injury that indicates a traumatic mechanism which indicates death...unless you can use a level 1 infuser, crack their chest and cross-clamp their aorta....


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[VentMonkey]

I think use of a c-collar in a suspected traumatic injury patient is probably not a bad idea. That c-collar can also help prevent neck flexion which may help to keep your endotracheal tube in place. It's written "consider c-collar use after intubation" in my protocols.

Moving a CPR patient on a backboard is also probably a good idea if you're doing manual compressions.

Intubating with a collar is a pain in the rump. It can be done, but it certainly not as easy as being able to manipulate the patient's head and neck as normal. I've always loosened the collar, had someone hold In line stabilization and then intubated. This is where VL makes a lot of sense.

This, basically. Don't be over analytical, use common sense, good judgment, and practicality. That is what this job mainly requires.

 

[NomadicMedic]

This might sound brash but if someone is in cardiac arrest and you suspect a c-spine injury that indicates a traumatic mechanism which indicates death...unless you can use a level 1 infuser, crack their chest and cross-clamp their aorta....


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Since were living in the world of hypotheticals…

How about an old guy who was climbing on a stepstool to change a lightbulb, had an MI, fell off and is in arrest on the floor. Its probably not a traumatic injury that would lead to arrest, but it is certainly a traumatic injury in the presence of an arrest. If I transported it at all, it should probably go collar and boarded, no?

 

[VFlutter]

That c-collar can also help prevent neck flexion which may help to keep your endotracheal tube in place. It's written "consider c-collar use after intubation" in my protocols.
.

Same here. Especially with pediatric patients.

 

[VentMonkey]

Same here. Especially with pediatric patients.

I am glad I wasn't the only one taught this. I have gotten a lot of looks when I have mentioned this regarding a pediatrics advanced airway management from the younger folks.

As if that magically little uncuffed tube is so secured as is in the first place in the back of a moving vehicle.

 

[DesertMedic66]

I am glad I wasn't the only one taught this. I have gotten a lot of looks when I have mentioned this regarding a pediatrics advanced airway management from the younger folks.

As if that magically little uncuffed tube is so secured as is in the first place in the back of a moving vehicle.

We got drilled on this during medic school. If we didn't put a collar on we automatically failed the pedi intubation station.

 

[VentMonkey]

We got drilled on this during medic school. If we didn't put a collar on we automatically failed the pedi intubation station.

Yes, but we had the same/ similar proctors. I am referring to the non-REMS CA folks I have encountered, and/ or trained.

 

[TXmed]

I am glad I wasn't the only one taught this. I have gotten a lot of looks when I have mentioned this regarding a pediatrics advanced airway management from the younger folks.

As if that magically little uncuffed tube is so secured as is in the first place in the back of a moving vehicle.

Almost one third of all pediatric ET tubes are found to be right mainstemmed or extremely shallow upon presenting to the hospital. That is not counting the ones that were extubated due to movement prior to getting to the ER. Those other folks can look at me funny all they want.

 

[AlwaysLearning]

Thanks everyone. All good replies. I appreciate it. What I'm gathering is it isn't always standard practice to put the collar on after intubating but it's a great idea. I haven't had to deal with it yet so I wasn't sure what I should expect that patient's head and ET tube to start doing as we package 'em up and transport 'em.

 

[DesertMedic66]

Anytime you have movement of the patient you have a risk of dislodging the tube. That is why tubes should be constantly reassessed and another good reason waveform capno is a great thing.

 

[TomB]

Thanks everyone. All good replies. I appreciate it. What I'm gathering is it isn't always standard practice to put the collar on after intubating but it's a great idea. I haven't had to deal with it yet so I wasn't sure what I should expect that patient's head and ET tube to start doing as we package 'em up and transport 'em.

We used to but now we don't. At the time we didn't have waveform capnography and every time an ED doc pulled one of our tubes the paramedic would say "it must have become dislodged between the back of the ambulance and the ED bed." A cervical collar may increase intracranial pressure. It's not worth it to me.

 

[Handsome Robb]

Since were living in the world of hypotheticals…

How about an old guy who was climbing on a stepstool to change a lightbulb, had an MI, fell off and is in arrest on the floor. Its probably not a traumatic injury that would lead to arrest, but it is certainly a traumatic injury in the presence of an arrest. If I transported it at all, it should probably go collar and boarded, no?

Collared sure, boarded no, unless you're using it is a movement tool and then we're not moving until we have sustained ROSC for 5-10 minutes here so we wouldn't have to interrupt compressions to place the board.

I didn't re-read the thread but IIRC it was when to place a board and collar. You can easily place a collar without interrupting compressions but there's no reason to interrupt compressions to place a LSB.

In your scenario I'd place the collar early then release it for the intubation then replace it.

On the topic of intubation, we're required to place a collar on any intubated patient to protect the tube.


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[VentMonkey]

Not sure about @DEmedic, but perhaps the old skool in me still prefers a hard surface between the patient and the compressor, i.e., the backboard long or short.

 

[NomadicMedic]

Not sure about @DEmedic, but perhaps the old skool in me still prefers a hard surface between the patient and the compressor, i.e., the backboard long or short.

Same thing with me. No LUCAS here, so it's all manual compression.

 

[Handsome Robb]

Not sure about @DEmedic, but perhaps the old skool in me still prefers a hard surface between the patient and the compressor, i.e., the backboard long or short.

[emoji848]

The floor is pretty hard but it's tough to get it between the patient and the compressor... [emoji23]



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[DrParasite]

So the first time I worked a cardiac arrest in NC, I did what I always did, and put a collar on the patient after they were intubated, to help protect the tube and to keep the head in a neutral position. Well, my FTO paramedic flipped, because if we bring a cardiac arrest patient to the hospital (which happens to be a Level 1 trauma center) with a collar on, they will immediately think spinal injury, which causes them to lose focus (or some other reason I guess), to which the paramedic will need to explain that it isn't on for a spinal injury, but rather to protect the tube, which will delay care and waste everyone's time.

Long story short, they don't put collars on intubated people, because it confuses the ER.

 

[NomadicMedic]

[emoji848]

The floor is pretty hard but it's tough to get it between the patient and the compressor... [emoji23]



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I'm in no-mans land here. They still scoop and scoot with arrests.

 

[cruiseforever]

I'm in no-mans land here. They still scoop and scoot with arrests.

How do their ROSC and neuro outcome rates compare to stay and play?