GSW/Stabbing Immobilization

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bnn987

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You arrive to find a victim with either a gunshot wound or a GSW that is alert and oriented with a GCS of 15. Bleeding is controlled and there is no airway compromise or breathing difficulty. Do you immobilize the patient due to MOI?
 
Hell no.

The number needed to treat with spine immobilization to potentially benefit one patient was 1,032. The number needed to harm with spine immobilization to potentially contribute to one death was 66.
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Penetrating injuries aren't a "high" mechanism as far as the spine's concerned. Gonna have to go with the above.
 
Are they shot in the spine?????
 
As stated above.

Glad we could do your homework for you.
 
bnn987 said:
You arrive to find a victim with either a gunshot wound or a GSW that is alert and oriented with a GCS of 15. Bleeding is controlled and there is no airway compromise or breathing difficulty. Do you immobilize the patient due to MOI?
Click to expand...

POC homie, POC
 
If someone has an isolated GSW or Stab Wound to an extremity no but I have seen plenty of GSW's that have pinballed around and the patients were more grievously wounded than previous thought due to location of enty wound. For example I had a patient with an entry wound to his left hip the fragment tracked through his pelvis and was lodged next to the patient's spine.
 
The plural of anecdote is not data. Read the study I posted.
 
If there is an entrance wound with no exit wound, then yes, I would immobilize. Had a pt last year shot once in there left shoulder with no exit wound and the bullet fractured his T10.

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Aidey said:
The number needed to treat with spine immobilization to potentially benefit one patient was 1,032. The number needed to harm with spine immobilization to potentially contribute to one death was 66.
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"Potentially contribute"? I would need better data on the types/severity of the 66 cases of "harm".


As for the original question: no provided they don't have neuro defecits (motor/sensory). GSW is definitely a high mechanism. It's just that neurological injuries tend to at the time of event...not down the line from turning the wrong way like with blunt trauma. So says PHTLS.

Local policy requires us to immobilize, though (unless patient is hypotensive).
 
Mad Russian said:
If someone has an isolated GSW or Stab Wound to an extremity no but I have seen plenty of GSW's that have pinballed around and the patients were more grievously wounded than previous thought due to location of enty wound. For example I had a patient with an entry wound to his left hip the fragment tracked through his pelvis and was lodged next to the patient's spine.
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Beside.

And I bet his wasn't moving much with that pelvis. Ideally, you'd use the scoop to get him onto the stretcher and just transport. I would make sure he laid as close to flat as possible, though.
 
AnthonyM83 said:
"Potentially contribute"? I would need better data on the types/severity of the 66 cases of "harm".


As for the original question: no provided they don't have neuro defecits (motor/sensory). GSW is definitely a high mechanism. It's just that neurological injuries tend to at the time of event...not down the line from turning the wrong way like with blunt trauma. So says PHTLS.

Local policy requires us to immobilize, though (unless patient is hypotensive).
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I believe the full text of the article is available online. Read the abstract I posted and if you still have questions search for the full text.
 
Aidey said:
The plural of anecdote is not data. Read the study I posted.
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HA! I like that.

As many have said, DO NOT BACKBOARD PENETRATING TRAUMA. Read the study that was posted.

Just think about it logically, if a bullet bounced around in a victims thoracic or abdominal cavity is your chief concern really spinal immobilization? How about any of the well fed organs residing in those cavities? Any of the massive vessels? The pump itself? Also, If the bullet severed the spinal cord then the damage is done, restricting their movement will not undo the spinal injury.

Critical trauma patients need surgeons, any action taken to increase the time it takes for the victim to get to a trauma surgeon worsens their outcome. So why spend 2 minutes back boarding someone if it doesn't change anything for the better? I think the last PHTLS book even says not to back board penetrating trauma.

Edit: another thought: Military deals largely with GSWs, do you see backboards as a regular part of a military medic's equipment?

I won't bring up the general effectiveness (or lack thereof) of backboards...
 
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AnthonyM83 said:
"Potentially contribute"? I would need better data on the types/severity of the 66 cases of "harm".
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http://www.ncbi.nlm.nih.gov/pubmed/20065766

So says PHTLS.
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PHTLS agrees that: "Because of the very low risk of an unstable spinal injury and because the other injuries created by the penetrating trauma often require a higher priority in management, patients with penetrating trauma need not undergo spinal immobilization." Seventh Edition, p. 256
 
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Data says no. Common sense says no.

Heck no.
 
Nope. No spinal motion restriction without neurological signs and symptoms.

We aren't required to spinal these patients by protocol either, thankfully.

Protocol says "Consider spinal motion restriction if indicated"
 
Long spine boards carry airway risks (enforced supine position) which can lead to pharmaceutic paralysis for an airway, etc etc. Just what you want in addition to a GSW.

TIme is part of the risk-benefit ratio. And don't treat based solely on MOI, treat based upon exam and complaint.
 
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