Melclin
Forum Deputy Chief
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I came late to this party and I am not happy about that.
Yeah especially when they didn't properly apply the NEXUS criteria when they tried to validate. I'm too drunk to go looking up where I heard that, but I heard it somewhere so it must be true
I personally use a combination of the two in my own practice. If they clear NEXUS, I ROM them and enjoy it all even more if I can find a low risk dot point to document as well. My favourite is ambulatory without deficit. Officially speaking a we cannot clear anybody who has had an LOC and our age cut off is 55, but I tend to ignore that if I can clear them with the combined NEXUS and CCR.
QUESTION FOR EVERYONE: "No period of LOC" is included in our clearance criteria, ie they cannot have had an LOC for even a moment if they are to be cleared. I have never been able to figure out why this would be the case. Anyone have any ideas?
I think this is a difficult issue to argue for. If you argue for LSBs at all, then I think you have to say its an all or nothing type of deal. Now I would argue against the LSB altogether except as an extrication device. But I think if you do advocate their use in pts failing the neuro exam then you are acknowledging that pts with discoligamentous injury benefit from a board. I don't think its right then to say that people who cannot be cleared for another reason only need to be "half" immobilised. They can't be cleared for a reason and the evidence suggests that, amongst those people, there will be pts with unstable injury from whom you have withheld the fullest precautions that you acknowledge are "necessary" in pts more likely to have injury. Either they can or they can't be cleared. If there is a cohort of pts who I was happy to sit up with a collar on, I'd probably just be clearing those pts in the first place.
I had a few problems with oldies and pressing on their neck and them replying with a yes to the question of does that hurt. I very much like the idea of simply pressing and looking for grimace or a spontaneous report of pain and it is something I employ in older pts who are otherwise fairly low risk. I do ask after ward as well but it contributes less to my index of suspicion if they say "well yeah...kinda" but they didn't spontaneously report or grimace and I also ask if it would be normal for them to have pain. Since combining this approach, I've not had any trouble pts who really don't seem to be injured based on gestalt and other specific parts of the exam but who do somewhat spuriously report some neck pain on palpation.
But I don't immobilise anyone :lol: I haven't boarded someone in like 4 months.
Food for thought anyway.
Yeah especially when they didn't properly apply the NEXUS criteria when they tried to validate. I'm too drunk to go looking up where I heard that, but I heard it somewhere so it must be true
I personally use a combination of the two in my own practice. If they clear NEXUS, I ROM them and enjoy it all even more if I can find a low risk dot point to document as well. My favourite is ambulatory without deficit. Officially speaking a we cannot clear anybody who has had an LOC and our age cut off is 55, but I tend to ignore that if I can clear them with the combined NEXUS and CCR.
QUESTION FOR EVERYONE: "No period of LOC" is included in our clearance criteria, ie they cannot have had an LOC for even a moment if they are to be cleared. I have never been able to figure out why this would be the case. Anyone have any ideas?
I think this is a difficult issue to argue for. If you argue for LSBs at all, then I think you have to say its an all or nothing type of deal. Now I would argue against the LSB altogether except as an extrication device. But I think if you do advocate their use in pts failing the neuro exam then you are acknowledging that pts with discoligamentous injury benefit from a board. I don't think its right then to say that people who cannot be cleared for another reason only need to be "half" immobilised. They can't be cleared for a reason and the evidence suggests that, amongst those people, there will be pts with unstable injury from whom you have withheld the fullest precautions that you acknowledge are "necessary" in pts more likely to have injury. Either they can or they can't be cleared. If there is a cohort of pts who I was happy to sit up with a collar on, I'd probably just be clearing those pts in the first place.
I had a few problems with oldies and pressing on their neck and them replying with a yes to the question of does that hurt. I very much like the idea of simply pressing and looking for grimace or a spontaneous report of pain and it is something I employ in older pts who are otherwise fairly low risk. I do ask after ward as well but it contributes less to my index of suspicion if they say "well yeah...kinda" but they didn't spontaneously report or grimace and I also ask if it would be normal for them to have pain. Since combining this approach, I've not had any trouble pts who really don't seem to be injured based on gestalt and other specific parts of the exam but who do somewhat spuriously report some neck pain on palpation.
But I don't immobilise anyone :lol: I haven't boarded someone in like 4 months.
Food for thought anyway.
