elevating feet on suspected spinal injury?

[mobile life]

hi everyone this is my first post so please forgive me, so my question is, on a patient with suspected spinal and a injury to tib or fib do you elevate the injured foot (after securing patient on a long board and splinting) to prevent sweling or just splint enrout without elevation?

 

[DesertMedic66]

Splint without elevation. Strap them to the board and the board to the gurney. You can splint the leg with a cardboard (or another type) splint. Ice packs usually help with swelling and can help a little bit with pain management.

 

[Akulahawk]

While a tib-fib is important of an injury, in the setting of a spinal injury, it's secondary. Just secure the patient on the board as you normally would, except for remembering that the straps should NOT go right on top of the likely fracture... and transport normally. In this setting, supine is fine...

I'd actually be more worried about distal circulation than taking special precautions to splint or raise the leg. Now if it's an isolated tib-fib and no spinal injury, that's a whole different deal.

En-route, if I have time, I'd be more than happy to revisit the tib-fib and begin pain control via ice pack. Done right, those things do work pretty well. Unfortunately, ambulances aren't stocked with ice machines...

 

[Cmidfield14]

Splint before moving them to spine board unless they are critical, then it is secondary.

If they are stable and a traction splint is applicable, do that.

Elevation won't help much with short term swelling. I wouldn't really move a suspected fracture, you don't want to make it worse, unless they have absent distal pulses.

 

[medichopeful]

If they are stable and a traction splint is applicable, do that.

For a tib-fib injury?:unsure:

 

[Cmidfield14]

For a tib-fib injury?:unsure:

I was referring to a femur of course. "if applicable"

 

[Epi-do]

Splint before moving them to spine board unless they are critical, then it is secondary.

If they are stable and a traction splint is applicable, do that.

Elevation won't help much with short term swelling. I wouldn't really move a suspected fracture, you don't want to make it worse, unless they have absent distal pulses.

Yeah, I'm, traction splints are only to be used for mid shaft femur fractures.

 

[Achilles]

Splint before moving them to spine board unless they are critical, then it is secondary.

If they are stable and a traction splint is applicable, do that.

Elevation won't help much with short term swelling. I wouldn't really move a suspected fracture, you don't want to make it worse, unless they have absent distal pulses.

I disagree, I wouldn't use a traction splint unless it was a femur fracture. If its suspected spinal injury, then that's key to splint.

 

[Handsome Robb]

I think the point has been driven home that you don't use a traction splint with a tib/fib injury.

Honestly if they are goin on the board I'm not too concerned about splinting their leg, the board does it for you. If I have time I might go back and make it pretty and if they aren't critical I'll do pain management prior to boarding them.

 

[STXmedic]

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

 

[medichopeful]

I was referring to a femur of course. "if applicable"

Ahh! Good wasn't sure!

 

[jwk]

Honestly if they are goin on the board I'm not too concerned about splinting their leg, the board does it for you.

Sorry, no, it does not.

 

[mobile life]

but is it indicated or counterindicated for suspected spinal to elevate ? (30 minute drive to nearest er having done splinting enroute) is it a good idea? To try minimizing sweling? and does it make any difrence?
Thanks.

 

[medichopeful]

but is it indicated or counterindicated for suspected spinal to elevate ? (30 minute drive to nearest er having done splinting enroute)

The Trendelenburg position is contraindicated in head/neck/spine injuries.

is it a good idea? To try minimizing sweling? and does it make any difrence?

This has been debated a lot! (the general use of Trendelenburg)

 

[nwhitney]

but is it indicated or counterindicated for suspected spinal to elevate ? (30 minute drive to nearest er having done splinting enroute) is it a good idea? To try minimizing sweling? and does it make any difrence?
Thanks.

Suspected spinal injury would be a contraindication to elevation of a lower extremity.

 

[Christopher]

...help a little bit with pain management.

Depending on the level of the spinal injury they may have no perception of pain to that area. They'll pretty much let you reorganize their tib-fib such that it is in a natural position when splinted.

Also keep in mind their lower extremities play no role in the spinal cord; so unless they have an unstable pelvic fracture as well you should be able to manipulate their legs without a problem.

 

[Christopher]

Suspected spinal injury would be a contraindication to elevation of a lower extremity.

Why? I don't recall the legs being a member of the vertebral column containing the spinal cord.

Suspected spinal injury would be a contraindication for the head/torso being at a downward angle. Granted this is expert opinion without any clear benefit or harm. Current evidence based guidelines make no mention of the prehospital positioning of the patient besides the vague "maintaining spinal alignment".

(not that I think elevation of the extremity would be of benefit for most EMS transports)

 

[nwhitney]

The OP (like me) is a Basic and for us it is a contraindication, at least in my Basic book it is. I actually agree with you beyond what you've posted.

 

[Christopher]

The OP (like me) is a Basic and for us it is a contraindication, at least in my Basic book it is. I actually agree with you beyond what you've posted.

The contraindication taught is using Trendelenburg positioning for neurogenic shock (i.e. head/torso at a downward angle).

The contraindication is not leg elevation in and of itself.

 

[DesertMedic66]

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).

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. If you tilt the whole board then the could possibly put too much pressure on a possibly compromised spine. If they are boarded then supine is fine.