Elderly Fall - Board/Collar

[Jon]

Here's a question - is the Pt. on any blood thinners? Plavix? Coumadin?

Around here, blood thinners + fall with any form of trauma to head = trip to trauma center.

If I'm going to a trauma center with this patient, I'm probably more likely to board and collar than otherwise.

As was said - if there is no back or neck pain, Pt. has no neuro deficits, and is CAOx4 - I don't see a reason I need to board the patient.

If i do board the patient - then I'm going to be careful to pad all void spaces with towels/blankets for comfort.

 

[Sasha]

This is an iffy one. On one side, you need to keep in mind that the elderly have decreased pain sensitivity and though she denies pain does not necessarily mean there is no injury. Also she may be frightened of the hospital or tired of it and trying to avoid another trip.

However I would avoid spinal immoblization as it has not been proven to be effective and may in fact worsen the problem. Geriatric bones and skin are brittle and break easily and I think a much better method would be to allow the patient to lay on the stretcher in a position of comfort.

 

[Melclin]

However I would avoid spinal immoblization as it has not been proven to be effective and may in fact worsen the problem. Geriatric bones and skin are brittle and break easily and I think a much better method would be to allow the patient to lay on the stretcher in a position of comfort.

Exactly. As I mentioned, I think there are quite a few situations where you don't necessarily suspect a spinal injury, but the pt still meets the criteria for immobilization, where simply having them lay still in a comfortable position is the best thing for them.

 

[redcrossemt]

If I'm going to a trauma center with this patient, I'm probably more likely to board and collar than otherwise.

Why's that?

 

[redcrossemt]

This patient would not have met my protocol for full spinal immobilization. However, as posted in another thread, I am required by protocol to place a cervical collar due to the risk of occult cervical fractures in the elderly (65+ y/o is our protocol).

 

[Fox800]

This is an area of contention at my agency. We are to "rule-in" spinal immobilization for any of the following four reasons:
1. Spinal pain/tenderness, referred pain, or pain to the musculature supporting the spine
2. Distracting injury (this includes ANY skeletal fracture...meaning that isolated hip fractures are supposed to be boarded...whether this happens or not is another story, depends from crew to crew)
3. Awake/calm/cooperative/sober patient...they must also have been conscious throughout the entire injury. If they don't remember what happened, they are considered to be unreliable.
4. Neurologic deficit (new or old).

I would have my partner hold manual c-spine while I evaluated the pt.'s neck/back, mental status, and neurologic function/motor strength. If all of those check out, we can clear c-spine. Keep in mind we have to balance this with the increased potential for injury in the elderly.

 

[EMT.Hart]

Yes. Fall, no matter what from or how high... We c-collar and back board.

"err on the side of pt. care" and I would rather over due than cause pt to be paralized.

 

[Sasha]

Yes. Fall, no matter what from or how high... We c-collar and back board.

"err on the side of pt. care" and I would rather over due than cause pt to be paralized.

Backboarding is NOT a harmless procedure and when considering backboarding someone you must take that into consideration. If the patient is older, you have to consider how long they might be IN that position before they can be cleared at the ER. Where did they come from? Do they have decubitus ulcers you are going to make worse forcing them to be on their back for lengths of time like that? Are you going to create some pressure ulcers? Are you going to create a fracture due to the patient's osteoperosis while you're forcing them into a rather unanatomically correct position?

You would promote even less movement if you allowed them to lay in a position of comfort than you would on a backboard. Backboarding is not proven to be effective.

A scenario for you. We once had an elderly gentlemen at nursing home with a stage III ulcer on his coccyx with wound vac, and two stage II ulcers on his buttocks. Patient lays on his side to promote healing and because laying on his back causes him considerable pain. Somehow the patient managed on fall on the floor( There is a major discrepancy on how the patient got to the floor. No one wants to take responsiblity for his fall.).

Knowing this patient has bedsores and that to lay him on his back will cause considerable pain, would you back board him? Don't you think a better option would be to allow the patient to lay in a position of comfort?

 

[Agent_J]

Standing takedown does sound best in that situation. I'd still Collar her regardless of the lack of neck pain as a precaution. I wouldn't want her to lay down or anything like that because that might cause more injury or pain for her.

Sounds like the right move.

 

[medicp94dao]

Ok... i am not questioning your pt care by any means... I know you said pt denied LOC, Neck/back- pain/tendernes... But did you do a HANDS ON evaluatiuon? If not remeber the elderly may have a diminished sense of pain or even an increased sense of pain. They do not feel things the way you and I do. A hands on evaluation may be the deciding factor on how your treatment goes. Maybe, she didnt feel any neck pain at the time of interview but, she may have felt pain if you physically checked for injuries with your hands.... ---> DCAP-BTLS.

What did she hit her head on? Concrete, wood, corner of table or did she hit it on carpet or mat on floor? This is a grey area... to immobilize or not to immobilize....

How was she feeling prior to fall? was she dizzy or SOB? Or did she simply slip? There could have been a medical reason as to why she fell.

If pt still denies any pain and is A&OX3 and has no visible or palbable injuries. Then no I wouldn't have c-collared and backboarded the pt. especially if she was against the idea... regardless of her families wishes.. just because she is older does not mean she isnt in charge of her own care. I know someone is going to bring up the fact that maybe her family is her medical POA.... That is only in the case if she can no longer competently make her owns decisions or if she is incapacitated.

If she was c/o pain from the backboard... was it properly padded? You dont have to have a fancy backboard pad... a few strategically placed towels will work fine.

I tell my students "Sometimes the best treatment for your pt is no treatment at all!!"....

Primum Non Nocere