Immobilize or not?

[HMartinho]

Our BLS unit was dispatched for an assault victim on a sidewalk. Male, 19 years old that was beaten several times in his belly, back and chest. He complains pain on his ribs, backaches, headaches and some shortness of breath. He's alert and orientated.

BP: 130-85
Pulse: 98
RR: 15
temp: 36,5 ºC/97,7 ºF
pupils are equal and reactive
pulse-ox: 93% on room air
breath sounds are normal
Pain: 5 on a scale between 0 to 10.

History of tipe I diabetes and allergy to penicillin.

On physical examination (head-to-toe), we don't found nothing of concern.

The question is: I proposed a full immobilization (as I learned in these cases), but my partner did not agree, and said: We don't find nothing special on physical exam,so it is not necessary. After a little reflection, my partner eventually agreed, and the patient was immobilized with backboard, c collar and head stabilizers.

He was transported to the hospital, with 3 liters of oxygen per minute via nasal cannula.

What do you think? We should immobilize or not?

 

[usalsfyre]

Any signs of spinal injury? Absent physiologic signs and symptoms there's no need to apply a treatment that has potential to cause harm. Would you give a patient with no signs of anaphylaxis an epi pen just because a bee stung them?

And for that matter, why the O2?

 

[ah2388]

You are somewhat limited by local guidelines, and until the receiving facilities embrace the "newish" research outlining the idea that spinal immobilization as performed currently pre hospital is often more harmful than helpful, you are likely limited to immobilizing patients like this.

With that being said, as I read the scenario, the pt does not appear to have any neuro deficit, nor any obvious indication of spinal injury, so I think its reasonable to forego immobilization.

 

[fast65]

I would not have immobilized him, there were no signs of spinal injury. No neck pain, no deformities/pain/tenderness noted on the spine, and neuros were grossly intact; at least I can infer that info from your post.

 

[exodus]

Does backaches not mean back pain?

 

[usalsfyre]

Does backaches not mean back pain?

Point tenderness on palpation of the spine vs generalized muscle pain mean vastly different things

 

[fast65]

Does backaches not mean back pain?

I consider backaches to imply muscular pain, and with his assessment he didn't specify where the backache was and whether or not there was any pain/tenderness to the spine.

 

[HMartinho]

He had no signs of spinal injury. No paresthesias, and had good strenght in legs, he only complains of pain,that's why I wanted to immobilize him.

We gave O2, because he had shortness of breath, and had a pulse ox of 93%. Our med-control along with it.

 

[HMartinho]

Does backaches not mean back pain?

yes... Sorry about my englishh34r:h34r:

On palpation, he complains back pain.

 

[fast65]

He had no signs of spinal injury. No paresthesias, and had good strenght in legs, he only complains of pain,that's why I wanted to immobilize him.

We gave O2, because he had shortness of breath, and had a pulse ox of 93%. Our med-control along with it.

Pain where though? Pain along the spine, on his neck, with palpation? Point tenderness? Generalized back pain in and of itself is not a good reason to immobilize an assault victim.

 

[HMartinho]

Pain where though? Pain along the spine, on his neck, with palpation? Point tenderness? Generalized back pain in and of itself is not a good reason to immobilize an assault victim.

When we arrived, beyond the questions to check alertness and orientation, we asked: Sir di you have any pain? He said my back, chest and head hurts. On palpation, it is more pain at the dorsal. Nevertheless, no paresthesias, and has good strenght in the legs, and sensitivity in all lower limb.

 

[fast65]

When we arrived, beyond the questions to check alertness and orientation, we asked: Sir di you have any pain? He said my back, chest and head hurts. On palpation, it is more pain at the dorsal. Nevertheless, no paresthesias, and has good strenght in the legs, and sensitivity in all lower limb.

So based on that, why did you immobilize? At what level of the spine was this back pain?

 

[DesertMedic66]

Back pain or any kind of pain in the back possibly caused by trauma = C-spine. I would have been ripped to shreads if I arrived at the hospital without C-spine.

 

[HMartinho]

So based on that, why did you immobilize? At what level of the spine was this back pain?

He complains more pain in dorsal level.

 

[HMartinho]

Back pain or any kind of pain in the back possibly caused by trauma = C-spine. I would have been ripped to shreads if I arrived at the hospital without C-spine.

Just as I learned

 

[fast65]

He complains more pain in dorsal level.

From my knowledge, dorsal implies the back side, not really a particular level. Was it lumbar, thoracic, or cervical spine pain?

 

[HMartinho]

From my knowledge, dorsal implies the back side, not really a particular level. Was it lumbar, thoracic, or cervical spine pain?

In Portugal we use different terminology: cervical, dorsal and lumbar. So, our dorsal is your thoracic. He had more pain in thoraccic level.

 

[fast65]

In Portugal we use different terminology: cervical, dorsal and lumbar. So, our dorsal is your thoracic. He had more pain in thoraccic level.

Ah, ok, thank you for the clarification.

 

[HMartinho]

I do I have to thank. I'm an English forum, so I have to use English terminology.

And sorry about my english. Gradually, I believe it will improve. h34r:

 

[exodus]

I do I have to thank. I'm an English forum, so I have to use English terminology.

And sorry about my english. Gradually, I believe it will improve. h34r:

Don't worry, you're doing fine! We're understanding you for the most part and you're willing to clarify!