GSW and backboard?

Raf

Raf

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I had my first GSW two nights ago. When we arrived at scene we found the pt. sitting on the sidewalk. He had one shot, into his back (a few inches from the most prominent vertebra), with no exit wound. The entrance wound was barely bleeding.

My partner wanted to longboard him but we decided not to. My question is, would it have been a good idea to backboard a GSW patient? It seemed kinda silly with so little time on our hands with internal bleeding a possible threat, but later I made the connection that the bullet came in pretty close to his spine and immobilization may have helped.
 
Raf said:
I had my first GSW two nights ago. When we arrived at scene we found the pt. sitting on the sidewalk. He had one shot, into his back (a few inches from the most prominent vertebra), with no exit wound. The entrance wound was barely bleeding.

My partner wanted to longboard him but we decided not to. My question is, would it have been a good idea to backboard a GSW patient? It seemed kinda silly with so little time on our hands with internal bleeding a possible threat, but later I made the connection that the bullet came in pretty close to his spine and immobilization may have helped.
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I would have backboarded him because you don't know what path the bullet took, especially with no exit wound.
 
I have 3 quadriplegic pts on vents in our rehab unit and one in the ICU whose entrance wounds were not right at the spine. It depends on the angle of entry and what might deflect the bullet to determine its path.
 
What about packaging them lateral? You still get the C-Spine control, and access to both back, and front of patient.
 
like stated above, no exit wound, shot near the spine, ya, some immobilization was needed, like you said, it wasn't bleeding much, so i'd put a good dressing on it. keeping a close eye on CMS, and put him on a board.
 
Lateral position if there is something pertruding from the body that could cause further damage.

In the ED, the patient will be rolled for assessment. The determination for intubation and an X-ray, usually supine, will be done immediately. A CT Scan may also be done usually in supine position.
 
Better safe than sorry. It shouldn't take all that long to board someone, and when you have a fairly significant MOI right to the back.... spinal immobilization should be a pretty high priority, I would imagine.
 
i would board and strap... i have had a few GSW and they don't bleed bad unless they hit a artery remember cauterization? Just remember what the bullet hit in its path. Remember small calibers even from close can not lead an exit wound but rather cavitate and sever the spine...even if they were shot way off from it. Like said above better safe then sorry.
 
GSW is considered trauma, and all trauma - unless impossible - should have C-Spine precautions taken. Especially physical assault and stabbings.
 
Know a medic who got real nervous for not packaging a GSW near the neck. ...It was broken.
 
Hastings said:
GSW is considered trauma, and all trauma - unless impossible - should have C-Spine precautions taken. Especially physical assault and stabbings.
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All trauma? So a broken arm needs to be backboarded? How about someone stabbed in the arm?
 
JPINFV said:
All trauma? So a broken arm needs to be backboarded? How about someone stabbed in the arm?
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I know that you know what I mean, and I know you're just asking that to cause me to reword what I said.

But I'll humor you.

Does everyone know where the spine is? Yeah, well, if anything hits the area around the spine (the core of the body, either front or back), or if the points of impact in an assault injury is unknown, the patient should be backboarded.

Should be. Textbook definition. Use common sense.
 
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Hastings said:
I know that you know what I mean, and I know you're just asking that to cause me to reword what I said.

But I'll humor you.

Does everyone know where the spine is? Yeah, well, if anything hits the area around the spine (the core of the body, either front or back), or if the points of impact in an assault injury is unknown, the patient should be backboarded.

Should be. Textbook definition. Use common sense.
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science.jpg


http://cat.inist.fr/?aModele=afficheN&cpsidt=15315716
http://www.ncbi.nlm.nih.gov/sites/e...ez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum
http://www.ncbi.nlm.nih.gov/sites/e...med.Pubmed_ResultsPanel.Pubmed_RVAbstractPlus
 
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I can't come to a quick conclusion from the first two, but the abstract of the third one suggests that there is no point in backboarding a GSW pt.
 
Raf said:
I had my first GSW two nights ago. When we arrived at scene we found the pt. sitting on the sidewalk. He had one shot, into his back (a few inches from the most prominent vertebra), with no exit wound. The entrance wound was barely bleeding.

My partner wanted to longboard him but we decided not to. My question is, would it have been a good idea to backboard a GSW patient? It seemed kinda silly with so little time on our hands with internal bleeding a possible threat, but later I made the connection that the bullet came in pretty close to his spine and immobilization may have helped.
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Your honor I rest my case!

The only problem was your partner listened to you, so now they may suffer the consequences. Ever heard of tumbling effect of a GSW? Are you sure it did not hit the bones or spine at all?

Sorry, not to be rude but I would start reviewing projectory & blasting injuries; and the care of trauma patients. As others stated, even laying them laterally would be accepted and possibly even better. One can immobilize multiple ways.

Again, study & rehearse, practice difficult immobilization scenarios. It is amazing how one can stabilize and immobilize patients. It would be far better than for an attorney to read just what you posted..

R/r 911
 
I would have to agree. This seems like a pretty easy one to me.
 
Ridryder911 said:
Are you sure it did not hit the bones or spine at all?
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That's exactly it. We are not doctors, we do not have x-ray vision, we simply do not know. We can make very good educated guesses based on what we see and have been told, but we just do not know. If the bullet was a few inches from the spine, then that should be a full package. I mean we have to use common sense at every call, but this should of been a no brainer. Package and go. It's always better to roll him into ER, and get the x-ray results and see that it totally missed anything vital, then to roll him in, get the x-ray results and find out it, or a part of it hit his spine and now he can't move his legs or something.
Now being your first GSW, it was a new experience, but we are trained to deal with whatever we see.. so hopefully next time if your partner doesn't want to package you will know it should happen.
 
Since I am the dumb or ignorant pre-student I have a few questions and well they are probably going to seem .........well rather stupid but these are just my observations....

Ok if I read the original post correctly the individual doing the care is a basic....( insert fun commentary from my other threads)
My first question is why is a basic making any decisions on a GSW is that not ALS????? Not to mention the nature of the GSW BLAH BLAH medical jargon it was freaking close to the spine if nothing else that seems Like and ALS call to me.......
It also seems funny to me if you are questioning whether you should back board or not shouldn't you back board just to be safe????????
Ok so no exit wound which logically would lead me to think well the bullet obviously didn't come out so its in there some where. what else did it tear up??? all those good little organs in there that make us work properly........Yeah ummmmm again ALS call.
If you are on an ALS unit then why was the medic asking you??? If the medic was asking your opinion because he doesn't know then I think its time to find a new medic..
Really I could go on forever questioning this.... my point is as far as your question goes back board the fool throw him in the truck rendezvous(sp) with ALS or get him to the ER.
 
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traumateam1 said:
That's exactly it. We are not doctors, we do not have x-ray vision, we simply do not know. We can make very good educated guesses based on what we see and have been told, but we just do not know. If the bullet was a few inches from the spine, then that should be a full package. I mean we have to use common sense at every call, but this should of been a no brainer. Package and go. It's always better to roll him into ER, and get the x-ray results and see that it totally missed anything vital, then to roll him in, get the x-ray results and find out it, or a part of it hit his spine and now he can't move his legs or something.
Now being your first GSW, it was a new experience, but we are trained to deal with whatever we see.. so hopefully next time if your partner doesn't want to package you will know it should happen.
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I don't really know that you need X-Ray vision when the patient is shot in the back (That's where the spine is). I know it's just about impossible to get a patient who is sitting on arrival to agree to full backboard C-Spine precautions, but as suggested, simply taking care in position and moving can do wonders.
 
Hastings said:
I don't really know that you need X-Ray vision when the patient is shot in the back (That's where the spine is). I know it's just about impossible to get a patient who is sitting on arrival to agree to full backboard C-Spine precautions, but as suggested, simply taking care in position and moving can do wonders.
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LMAO agree to full back board????? I didn't realize they had to agree. Isn't that what Duct tape is for????????
 
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