Immobilize or not?

[savelives]

Working event staff for a 46 hour long dance marathon where the dancers do not sit or sleep for 46 hours. At hour 45 a dancer collapses to the floor and is conscious but has a gcs of 3/4/4. The crowd is cheering so loud at the time that we can barely communicate with him however bystanders tell us that they caught him before he hit the ground. Essentially I take this with a grain of salt and begin a rapid trauma, looking for any deformities or sources of pain. I strip his shoes and find pulses present and equal ever. This kid has been standing for 45 hours so obviously he is altered. We get him on the stretcher and halfway to the truck he tells me his neck hurts so immediately I take cspine and declare that he needs to be boarded. My partner feels his neck asking him if certain places hurt and then declares that the pain is purely muscular do we can forget the boarding. My question to you is: is that in our scope of practice to determine if a pain is muscular or skeletal. Was it the right move
Not backboarding him?

Thanks

 

[DrankTheKoolaid]

re

That depends on your local protocol and level of education/experience to determine if you are comfortable ruling things out in the field vs just boarding everyone.

 

[NomadicMedic]

Do you have a spinal clearance protocol?

(I would not have boarded him)

 

[DPM]

Do you have a spinal clearance protocol?

(I would not have boarded him)

That's the key here. I think it was Sasha who posted an article to a Backboard study? Have a quick search for that.

 

[JPINFV]

Depends on the examination, which with something like determining skeletal vs muscular pain really does require you to be there.

 

[Medic Tim]

Do you have a spinal clearance protocol?

(I would not have boarded him)

What he said

 

[Tigger]

I would not have boarded him once he was on the stretcher. Neck pain does not always indicate spinal motion restriction. Given the circumstances above, it's likely he was just sore.

The whole better safe than sorry line doesn't fly with me. If ,on further assessment spinalling someone is necessary that's fine, but just because one is not absolutely sure of what happened does not mean they need a board.

 

[Maine iac]

All depends on your protocols and how comfortable you feel with the situation (like somebody already said). I would NOT have put him/her on a board. The MOI isn't really there IMO (slumping to the ground, with bystanders saying he was caught/lowered to the ground).

http://roguemedic.com/2011/10/video-of-spinal-immobilization-and-abandonment/

 

[Aidey]

Yes, you can determine if pain is muscular or skeletal. I also would not have back boarded him.

 

[Mountain Res-Q]

Wouldn't have regardless of protocol. Treat the patient based on the medicine, NOT based on a protocol written in 1982.

 

[frdude1000]

Our protocols in MD state these are the indications for back boarding:
(2) If patient presents with a traumatic mechanism which could cause cervical spine injury and meets ANY of the following criteria, complete Spinal Immobilization (C-spine and back maintaining neutral alignment and padding when appropriate) should occur.
(a) History of Loss of Consciousness (LOC) or Unconscious?
(b) Disoriented or altered LOC?
(c) Suspected use of Drugs or Alcohol?
(d) Midline Cervical Tenderness or Pain?
(e) Focal Neurologic Deficit?
(f) Has a painful distracting injury that could mask cervical pain or
injury?
(g) Child less than 8 years of age

I guess in your case the main question is how hard/distance of fall was and if the pain in the neck was midline or not.

 

[Mountain Res-Q]

our protocols in md state these are the indications for back boarding:
(2) if patient presents with a traumatic mechanism which could cause cervical spine injury and meets any of the following criteria, complete spinal immobilization (c-spine and back maintaining neutral alignment and padding when appropriate) should occur.
(a) history of loss of consciousness (loc) or unconscious? every night
(b) disoriented or altered loc? every morning
(c) suspected use of drugs or alcohol? yep... The bottle is enpty
(d) midline cervical tenderness or pain? you know it
(e) focal neurologic deficit? probably
(f) has a painful distracting injury that could mask cervical pain or
injury? my brain hurts
(g) child less than 8 years of age i act that way

i guess in your case the main question is how hard/distance of fall was and if the pain in the neck was midline or not.

quick... Backboard me!!!

 

[Akulahawk]

Depends on the examination, which with something like determining skeletal vs muscular pain really does require you to be there.

It very much does depend upon me actually being there at the time to do my own assessment to determine whether I'm eliciting muscular pain or skeletal pain. This is not something that can be adequately taught over this kind of medium.

Ground-level fall with sx that do not lead me to suspect a spinal injury = me not doing a full-on spine boarding. From what little I've gleaned from this thread, I would probably NOT board this patient. The ALOC probably isn't a result of the fall...

That being said, if I'm absolutely directed to board, I'd have to and hate every moment of it.

 

[Handsome Robb]

I agree with everyone else. From the information provided I wouldn't have boarded this guy but, like everyone else, I'd have to be there and make my own decision.

 

[Bullets]

Im actually surprised so many said do not backboard

According to NEXUS

1. No posterior midline cervical spine tenderness
and
2. No evidence of intoxication
and
3. Normal level of alertness
and
4. No focal neurological deficit
and
5. No painful distracting injuries

Patient has to pass all of those, and he fails #1 and #3 so it looks like SMR

 

[Aidey]

First, in order for nexus to apply we have to have reason to suspect a cervical injury. I don't. We also have no idea what the OP means by altered. Did the kid fail to know what day it was because he has been awake for 45 hours? In addition it sounds like his partner ruled out midline pain.

 

[Maine iac]

How about we change it a little..... You are in your ambulance driving wherever because dispatch has you changing stations and you see a few drunk people, one falls over and is now on the ground.

Do you
a) Flip the lights and sirens on for a second, pull a U turn and go over to check out the group?

b) Do everything in option 'a' but because the person fell, is intoxicated and is now combative do you assume he has a spinal injury and a head injury, and gets all the medical torture that we do to those patients?

c) Slow down to see if anybody in the group notices you are going by and tries to wave you down?


Jokes aside, with all of my patients they have to score specific points before I provide a treatment. Those points might be the parts a, b, and c on my protocols or how I choose to evaluate them. For this patient, how it is presented in the OP they do not move past me checking for MOI.

 

[JPINFV]

D: Turn down an ally before anyone has a chance to wave you down.

 

[savelives]

Our protocols in MD state these are the indications for back boarding:
(2) If patient presents with a traumatic mechanism which could cause cervical spine injury and meets ANY of the following criteria, complete Spinal Immobilization (C-spine and back maintaining neutral alignment and padding when appropriate) should occur.
(a) History of Loss of Consciousness (LOC) or Unconscious?
(b) Disoriented or altered LOC?
(c) Suspected use of Drugs or Alcohol?
(d) Midline Cervical Tenderness or Pain?
(e) Focal Neurologic Deficit?
(f) Has a painful distracting injury that could mask cervical pain or
injury?
(g) Child less than 8 years of age

I guess in your case the main question is how hard/distance of fall was and if the pain in the neck was midline or not.

he was definitely altered, and it was probable that he had a LOC. hmm. i appreciate all the answers to my thread but i'm only about a year experienced and I'm confused as to why you would not backboard him just to be safe?

thanks guys

 

[Aidey]

Go to pubmed.com search for articles about c-collars or backboards. Spend some time reading them and you will be able to answer your own question.