Realistically, take c-spine for everything?

[bunkie]

They have us taking C-spine for every-single-thing. I'm just wondering if in the field you're going to be collaring a pt that has stomach pain because he "may have fallen and not remembered". Just curious. Thanks in advance.

 

[Lifeguards For Life]

probably not. if the patient is tolerant, it could cover you and your partner of any legal ramifications.
If we choose not to immobilize a patient like the one in your scenario, and document pertinent negatives, and can logically explain why we choose not to do so, our medical director is okay with that.
If you are going to break a protocol though, it helps to be right.

 

[Sasha]

I found this webpage to be helpful about deciding whether you believe a patient should be immobilized for every little trip and fall or not.

http://journals.lww.com/em-news/pag...=2002&issue=11000&article=00024&type=fulltext

In your scenario, though, absolutely not unless there is sometihng to indicate he might have fallen or that he is altered or that he may have blacked out.

 

[Dominion]

I had a similar experience in EMT school, well more to the point on any medical scenario we did we of course asked "any trauma or falls associated?" and the proctor/instructor would say yes or no, and then we'd go down a line of questions to indicate whether or not collar/board would be needed.

In most field patients that are having a 'medical' complaint, no, you're not going to board and collar them. It depends on the call of course, a seizure? I might consider it depending on what happened. Someone sick/dizzy and just fell down in the yard? Probably not, but if you feel the mechanism was enough to warrant c-spine precations, don't hesitate to do it. The ER staff might get whiney about it but you're CYA and at the same time being a patient advocate.

 

[Shishkabob]

If the CC is indicative of something that can cause spinal trauma, and your protocols don't allow you to clear, then do cspine.

 

[JPINFV]

Have you ever been to an ER as a patient?

When you walked in, did the first thing the triage nurse do is take manual inline stabilization?

 

[Shishkabob]

I had to hold cpsine for over an hour on someone in the ED yesterday... Least they could have done is raised the bed so that it was easier on my 6'1" body, but NOOO... the doc was short, so I was crouched over the whole time.

 

[Dwindlin]

We are fortunate enough to have a clearance protocol, so no I don't immobilize everything.

 

[akflightmedic]

I had to hold cpsine for over an hour on someone in the ED yesterday... Least they could have done is raised the bed so that it was easier on my 6'1" body, but NOOO... the doc was short, so I was crouched over the whole time.

Interesting.

I would simply instruct them not to move, if that did not work then you have the options of (Gasp) Blankets and Tape!!!

Does no one remember those? Why would you hold cspine for an hour in a facility? Did not a single ambulance crew come in during that time from which to grab equipment from? Does the ER not keep a set handy for those walk in patients that require it?


Just rapid firing here, I am sure there is more to it but you certainly need to share.

 

[Shishkabob]

Meh, no clue. Football player came in complaining of tenderness and pain to the area of C3-C7, doc told me to take cspine. Xrays taken, and I was in there for an hour holding his head while the trauma docs looked at the pics.


Busy day in the photo-development lab I guess? :unsure:


That or they felt bad for having such a boring day for a medic student, so they thought cspine was better than nothing.

 

[VCEMT]

We just C-spine people that have neck or spinal pain, spinal tenderness, a painful distracting injury (e.g., long bone fracture), neurological deficit, or inability to communicate effectively.

We also consider it for ETOH patients. You never know, Odis might of tumbled off the barstool.

 

[Akulahawk]

You might not have to actually take the equipment with you... but you should always "consider" whether or not your patient needs spinal immobilization. I don't think you'll fail for verbalizing "considering/asking" about the need for spinal immobilization. Remember, medical calls can result in some odd falls, meaning a medical problem can precipitate a trauma...

 

[RescueYou]

Interesting.

I would simply instruct them not to move, if that did not work then you have the options of (Gasp) Blankets and Tape!!!

hahaha AMEN!!!!

 

[wyoskibum]

They have us taking C-spine for every-single-thing. I'm just wondering if in the field you're going to be collaring a pt that has stomach pain because he "may have fallen and not remembered". Just curious. Thanks in advance.

Well initially you should be thinking about and protecting C-Spine, especially if you find your patient supine. Some schools teach ACBC: Airway, C-spine, Breathing, Circulation. Manually stabilize the head until you can assess if there is an injury and/or need for further stabilization.

If I have a medical patient, I will do my assessment and only if there is the possibility of trauma and/or altered mental status would I consider spinal immobilization.

 

[RescueYou]

Some schools teach ACBC: Airway, C-spine, Breathing, Circulation.

We teach something like that here. It's ABCS- airway, breathing, circulation, spine/stabilization. Optional though.

 

[Achromatic]

We teach something like that here. It's ABCS- airway, breathing, circulation, spine/stabilization. Optional though.

One of our paramedic instructors favorite lines for trauma is AO2BC...

But in terms of our practicals, we were told that for things like that we could say "Review need for spinal immobilization" and that that would be sufficient, on the proviso that we would need to expect the possibility of the question back being "How do you do that?". Likewise, we were told "don't mindlessly chant 'scenesafebsi' at the start of every practical, and to expect questions at that point of "well, -what- BSI might be indicated here? what might you look for in establishing scene safety?"

 

[redcrossemt]

They have us taking C-spine for every-single-thing. I'm just wondering if in the field you're going to be collaring a pt that has stomach pain because he "may have fallen and not remembered". Just curious. Thanks in advance.

You might have to collar every patient with a traumatic injury. However, collaring a patient that only complains of stomach pain is not necessary, not standard practice, will cause pain and possibly bad outcomes, and may get you in trouble.

For traumatic injuries, we have spinal immobilization criteria. We have to immobilize patients with a mechanism of injury suggestive of spinal injury with one or more of the following:

- Spine Pain
- Spinal Tenderness
- Intoxicated / Not Reliable
- Altered Mental Status / Unconscious
- Distracting Extremity Fracture or Other Injury
- Neurological Defecity

I will also note that we are required to collar, but not necessarily backboard, all patients over the age of 65 with a mechanism suggestive for spinal injury. This is due to the number of occult fractures reported as not detected by the primary clinical exam as above.

 

[Kevin1990]

c=spine

depending on you're local protocols, whether or not to cspine. With mine here in ohio, its anyone who is suspected of a head injury, fall/ concerning injury to the back neck, or head area. and of course and blunt injury the head or back. But for stomach pain. depending on the situation. How did u find the pt? layin face down on the floor, or sitting on the floor? those are things to think about when ur doing ur assessment. hope that helps and makes sense.

 

[Fox800]

You should take manual spinal immobilization if the patient has experienced a mechanism of injury that may have applied forces to the spinal column. Therefore, you don't need to hold c-spine for a medical patient complaining of abdominal pain. We only initiate spinal motion restriction if there is a complaint suggesting possible spinal injury or if the patient has been involved in an MOI that would obviously have the potential for spinal injury (fall from significant height, diving injury, ejection, etc...those are just examples, there are other situations).