elevating feet on suspected spinal injury?

[Christopher]

Never had to use a traction splint in the field. Main reason is because if it's on the patient, the patient can not fit into the back of the ambulance. (I know this isn't the main topic of the thread).

Yeah, they're sorta a pain to use if they're on a long board. If they're on a Reeve's Sleeve or a short board, it's not that big of a problem. Although you don't really see short boards much anymore.

Trendlemburg (sp?) is contraindicated in C-Spine immobilization. If you elevate just the leg then it's not gonna be too secure on the backboard.

You can elevate a single extremity on a long/short board pretty easily with blankets, but given usual EMS transports there is little benefit.

If you tilt the whole board then the could possibly put too much pressure on a possibly compromised spine.

While that is the prevailing theory, it's not really supported in the literature. There is support for head elevation in CVA care, but none for spinal injury.

However, you hit the nail on the head:

If they are boarded then supine is fine.

 

[Epi-do]

Never had to use a traction splint in the field. Main reason is because if it's on the patient, the patient can not fit into the back of the ambulance. (I know this isn't the main topic of the thread).

Just a quick comment about this. If you put them on the cot backwards (head at foot of cot) then you don't have to worry about the traction splint getting in the way of the doors. If you've got a short board, tie it down to the end/head of the cot so it can support the end of the traction splint.

And now, back to the regularly scheduled thread...

 

[DesertMedic66]

Just a quick comment about this. If you put them on the cot backwards (head at foot of cot) then you don't have to worry about the traction splint getting in the way of the doors. If you've got a short board, tie it down to the end/head of the cot so it can support the end of the traction splint.

And now, back to the regularly scheduled thread...

This is what we teach at my college. However we can't do it here. Company policy makes it mandatory that we use a 5 point seatbelt system on all patients. If the patient is placed backwards we can't use the 2 shoulder belts.

 

[Akulahawk]

Narc 'em out, throw an air splint on real quick, and board. Done.

I wouldn't use an air split. I'd much rather use a vacuum splint. More comfortable to remove.

 

[mobile life]

thank you all for the input, reason for my question, to make sure we did the right thing because at the end patient couldnt get surgery because his leg got so swolen i started thinking that maby we should have elevated (it was quiet a long ride to er) .
Thanks again.

 

[Tigger]

This is what we teach at my college. However we can't do it here. Company policy makes it mandatory that we use a 5 point seatbelt system on all patients. If the patient is placed backwards we can't use the 2 shoulder belts.

That is a silly policy considering that the traction splint is one of the more useful devices an EMT can use, especially in the absence of pain control.

 

[Medic Tim]

That is a silly policy considering that the traction splint is one of the more useful devices an EMT can use, especially in the absence of pain control.

Where I work it is provincial regulation to have the shoulder straps on all pts. If we don't use them and are caught, we will be suspended.

 

[Tigger]

Where I work it is provincial regulation to have the shoulder straps on all pts. If we don't use them and are caught, we will be suspended.

It is in our statewide protocols do so as well, but then again so is the use of traction splints for femur fractures. Which one to choose?

Back on track, the "elevation" used by EMS is not significant enough to do much. If you want to reduce swelling in the knee or ankle (anywhere really), that leg needs to be damned near vertical to be effective.Good luck doing that in an ambulance.

 

[STXmedic]

Back on track, the "elevation" used by EMS is not significant enough to do much. If you want to reduce swelling in the knee or ankle (anywhere really), that leg needs to be damned near vertical to be effective.Good luck doing that in an ambulance.

Cable system with IV tubing and the Oh S*%# bar? :unsure:

 

[Handsome Robb]

Narc 'em out, throw an air splint on real quick, and board. Done.

Can we be partners?

Sounds like we've got the same style

My favorite flavor is fentanyl and versed. Works like a charm.

 

[STXmedic]

Can we be partners?

Sounds like we've got the same style

My favorite flavor is fentanyl and versed. Works like a charm.

I'm down! But come here, we have more toys

Fent and versed is an awesome combo. Especially the quick IN Fent while waiting for a line. We just got Etomidate and Ketamine is arriving shortly, so my severe pain combo may be changing soon

 

[Handsome Robb]

I'm down! But come here, we have more toys

Fent and versed is an awesome combo. Especially the quick IN Fent while waiting for a line. We just got Etomidate and Ketamine is arriving shortly, so my severe pain combo may be changing soon

I'm jealous! There's no way NV EMS will ever allow medics to have ketamine, it was like pulling teeth to get our flight medics etomidate and I don't even know if they are allowed to administer it yet.

I heard a rumor we are getting CPAP but we will see, I'm down to move to Texas. Let me just finish up school, graduation is 7/13!

I'm not a huge fan of IN fentanyl but in a pinch it'll work. I've never gotten the results I wanted with it.

Crap I'm going to have to split myself. I told fast I'd be his partner too...his system is too slow though, sorry buddy!!!

 

[Aidey]

I hate you both. I'm not allowed to give opiates and benzos together unless I'm intubating. Even with online medical direction you will get yelled at by our MD.

 

[mycrofft]

Elevation of legs for shock is being phased out. I don't even have elevation of injured limbs as a basic first aid measure anymore, not for a long time.

Putting a person strapped supine on a spineboard in Trendelenburg is a great way to shut off their airway. If there is a possibility of intracranial injury by the MOI that occasioned use of the board, Trendelenburg would not help that.

We always immobilized legs and arms with spine boarding because limbs are levers which can move the torso (and hence spine), and furthermore they are (hopefully) attached to the pelvic and shoulder girdles, which are other lever to move the spine. Try lying supine on the floor, then raise one leg without feeling musculoskeletal involvement of the pelvis and sacrum.

How about this: spineboard and maintain airway; pillow splint between good and bad legs while on board; ice to affected leg as tolerated without causing thermal injury and relief of constriction to help prevent or alleviate swelling?

Mobile, sometimes they just have to delay surgery for swelling. It happens.

 

[mobile life]

Elevation of legs for shock is being phased out. I don't even have elevation of injured limbs as a basic first aid measure anymore, not for a long time.

Putting a person strapped supine on a spineboard in Trendelenburg is a great way to shut off their airway. If there is a possibility of intracranial injury by the MOI that occasioned use of the board, Trendelenburg would not help that.

We always immobilized legs and arms with spine boarding because limbs are levers which can move the torso (and hence spine), and furthermore they are (hopefully) attached to the pelvic and shoulder girdles, which are other lever to move the spine. Try lying supine on the floor, then raise one leg without feeling musculoskeletal involvement of the pelvis and sacrum.

thats interesting so what good does a KED (short board) for a patient with spinal

 

[mycrofft]

As many of these young(er than me) instructors DON'T teach, or hot to trot students don't learn, is that the KED is an extrication device, just as the long spine board is an extrication and transport device. Neither is curative, they are splints. The KED and short board are for when the pt is in a situation they can't be placed on the long spine board without much manipulation, such as rear seat on two-door vehicles or technical extrication. They are also a way to help make SURE there is minimal cervical movement if you don't have head blocks on your long board.

Personally, I like the KED a lot, having learned on short spine boards.

PS: to quote myself,
"Try lying supine on the floor, then raise one leg without feeling musculoskeletal involvement of the pelvis and sacrum."
I literally mean it. Try it. Also, everyone who is going to be spine boarding patients ought to be treated to the sort of rapid/expedient spine boarding they would receive in the field, preferably resulting in a ride on the litter in the ambulance around the block at about forty to fifty miles an hour. Extremely educational.

 

[Christopher]

thats interesting so what good does a KED (short board) for a patient with spinal

Nothing we do works for spinal immobilization.

There is no data to support using anything we currently have.

There is data supporting that everything we currently have causes harm to our patients.

 

[mycrofft]

Yes, but...

What we have, if used judiciously, will certainly be better than not using anything. Even such goodies as vacuum splinting can lead to iatrogenic harm during positioning, or if positioning is foregone because it is judged to be unnecessary (or the operator is in too much of a hurry). As far as technical auto extrication (anything beyond just opening the door), SOME sort of smaller spinal splint is often necessary and probably demanded by protocols (since EMT's and car crashes needing spinal precautions are conjoined twins).

The trouble is that, due to oversimplification and administrative pandering to the lowest common denominator and risk, the spineboard came to be regarded as being like "mother's milk". They took the decision step away from the tech, and didn't teach her/him how to decide.

I believe there is data supporting what's being done if it is being done right, in appropriate cases, and when the risk benefit ratio (not blind protocols) favor it. I was told initial studies after EMS (and use of spine boards) was started supported continued use of spinal immobilization, as imperfect as it is, as evidence by fewer people dying from spinal injuries due to motor vehicle accidents. (The was the late Sixties, though, before universal seat belts or seatbelt laws, or airbags, or shock absorbing steering columns, or crumple zones, or improved roadways and barriers....).

 

[Christopher]

What we have, if used judiciously, will certainly be better than not using anything.

C-collars cause inappropriate A-O extension, long spine boards don't protect against lateral mobility, nor do they ensure proper alignment for anyone with any sort of curvature...

I don't disagree that the principle of ensuring the spine stays immobile if injured is appropriate and shown to work.

I disagree that our tools and techniques allow us to do so effectively. Perhaps we could, but we're not exactly working to change anything.

 

[mycrofft]

Agreed.

We need something better, hopefully simpler, with a protocol and assessment routine to make it work.

The first and second editions of the American Academy of Ortho Surgeons text for EMT (The Orange Book) actually had pictures so you could make your own spine boards. That as about 1973 and 76 I think.EMS was partially a cottage industry then, so rural and frontier areas could have it as well, so measures were crude and we just made them a little less so as time went on (stopped using plywood and now use polyethylene boards, etc).
Maybe a new thread to explore this?