C-Spine precautions for penetrating trauma.

[Smash]

For the "OMG he's been shot/stabbed, tie him to a lump of wood, STAT!" crowd...

From the Executive Committee of Prehospital Trauma Life Support, published in the Journal of Trauma - Injury, Infection and Critical Care, September 2011:

PHTLS Recommendations

• There are no data to support routine spine immobilization in patients with penetrating trauma to the neck or torso.

• There are no data to support routine spine immobilization in patients with isolated penetrating trauma to the cranium.

• Spine immobilization should never be done at the expense of accurate physical examination or identification and correction of life-threatening conditions in patients with penetrating trauma.

• Spinal immobilization may be performed after penetrating injury when a focal neurologic deficit is noted on physical examination although there is little evidence of benefit even in these cases.

(Prehospital Spine Immobilization for Penetrating Trauma—Review and Recommendations From the Prehospital Trauma Life Support Executive Committee. Journal of Trauma-Injury Infection & Critical Care September 2011;71(3):763-770)

 

[VCEMT]

Interesting, until the spinal immobilization policy in my county changes...


...It is a good read.

 

[JPINFV]

Ventura's protocol seems pretty reasonable. According to it, it's already not indicated in penetrating abdominal patients or in torso patients who aren't critical to the point where you can't do a decent exam.

http://www.vchca.org/emspolicies/0614_Spinal_Immobilization.sflb.ashx

 

[Katy]

All of these are interesting.

 

[LondonMedic]

Does this actually need to be said?

 

[JPINFV]

Does this actually need to be said?

Since the general mindset in American prehospital care is trauma=c-spine, yes. After all, the weakest bones in the body are apparently the vertebral column.

 

[LondonMedic]

Since the general mindset in American prehospital care is trauma=c-spine, yes. After all, the weakest bones in the body are apparently the vertebral column.

Baby jesus is crying right now!

 

[usafmedic45]

After all, the weakest bones in the body are apparently the vertebral column.

Depends on if you are talking about longitudinal or axial loading....

Sorry....couldn't resist.

 

[JPINFV]

 

[usafmedic45]

Nice. You would not believe the amount of time I spend trying to figure out how to better protect the spine in aircraft crashes. Roughly about the same amount of time that VentMedic likely spends coming up with new personae on this forum. LOL

 

[Smash]

Nice. You would not believe the amount of time I spend trying to figure out how to better protect the spine in aircraft crashes. Roughly about the same amount of time that VentMedic likely spends coming up with new personae on this forum. LOL

I LOL'd

And LondonMedic, sadly yes, this does need to be said, for the reasons the others have stated. Never forget how low the lowest common denominator can be...

 

[Aidey]

I noticed there were also two other studies on assessing spinal injuries. It looked like a good clinical assessment found all of the clinically significant spinal injuries in patients with penetrating trauma and distracting injuries.

I vote we give all the back boards to the dodo birds for use as firewood.
Not sure what we should do with the plastic ones. Skis for wooly mammoths?

 

[VCEMT]

I didn't read the article, I'm not subscribing. I was thinking trauma triage, stabbings and shootings are Step 2 traumas and require transport to a trauma center.

 

[Akulahawk]

Nice find... but that 'ain't penetrating trauma unless that diving board has a spike on it...

 

[socalmedic]

I didn't read the article, I'm not subscribing. I was thinking trauma triage, stabbings and shootings are Step 2 traumas and require transport to a trauma center.

just because they meet triage criteria to a trauma center, does that mean they must be immobilized?

 

[platypus]

Journal

For the "OMG he's been shot/stabbed, tie him to a lump of wood, STAT!" crowd...

From the Executive Committee of Prehospital Trauma Life Support, published in the Journal of Trauma - Injury, Infection and Critical Care, September 2011:

PHTLS Recommendations

• There are no data to support routine spine immobilization in patients with penetrating trauma to the neck or torso.

• There are no data to support routine spine immobilization in patients with isolated penetrating trauma to the cranium.

• Spine immobilization should never be done at the expense of accurate physical examination or identification and correction of life-threatening conditions in patients with penetrating trauma.

• Spinal immobilization may be performed after penetrating injury when a focal neurologic deficit is noted on physical examination although there is little evidence of benefit even in these cases.

(Prehospital Spine Immobilization for Penetrating Trauma—Review and Recommendations From the Prehospital Trauma Life Support Executive Committee. Journal of Trauma-Injury Infection & Critical Care September 2011;71(3):763-770)

How can i get access to this journal??

 

[VCEMT]

just because they meet triage criteria to a trauma center, does that mean they must be immobilized?

No, unless, they meet spinal immobilization criteria.

 

[LondonMedic]

No, unless, they meet spinal immobilization criteria.

And the point of all this is that those criteria are probably rubbish.

 

[VCEMT]

Until, my county's medical director says otherwise, I follow policies.

 

[Smash]

How can i get access to this journal??

Some organizations such as universities, hospitals or workplaces will have access to a range of journals. Otherwise you can subscribe yourself.

Until, my county's medical director says otherwise, I follow policies.

I'm so glad I don't have to work like that.