Rep Giffords was shot in the head, and seeing this picture I ask: Why the C-collar?

[Hockey]

Photo here.

I notice they have her on a board. Great, I board pretty much any significant GSW.

But then I noticed they have her collared. Just wondering, is it really needed to collar someone with that kind of wound? Traumatic arrest I would I'm sure just to keep the head from moving. If I have time. I suppose for precautions when they fallen but can't think of anything else.

 

[firecoins]

First their is the unknown path of the bullet. Than and immediate jerking and fall to the ground. Why would you not put a c collar on?

The person pictured is bleeding from her head. board and collar seems automatic.

 

[JPINFV]

First their is the unknown path of the bullet.

My understanding is that the injury was a through and through gunshot entering at the temple and exiting through the forehead. That seems to be a pretty well known path.

Than and immediate jerking and fall to the ground. Why would you not put a c collar on?

So, everyone who suffers a fall needs to be c-spined? Little 8 year old Suzie who trips playing at the park needs to be c-spined?

The person pictured is bleeding from her head. board and collar seems automatic.

http://www.youtube.com/watch?v=YzYxz_uvtSI

 

[Hockey]

Sorry mmiz I didn't think that could violate copyright policy since its a photo and embedding photo into the post.


Either way, this is the original source with better quality

http://news.yahoo.com/s/yblog_theti...tern-who-likely-saved-gabrielle-giffords-life

 

[MMiz]

Sorry mmiz I didn't think that could violate copyright policy since its a photo and embedding photo into the post.


Either way, this is the original source with better quality

http://news.yahoo.com/s/yblog_theti...tern-who-likely-saved-gabrielle-giffords-life

Fixed, thanks.

 

[firetender]

With a wound that serious to the head, you want to make sure it doesn't fall off.

 

[abckidsmom]

Why cut her clothes off, if it was just a through and through GSW?

It's because of what you might not know. Likely the reason why c-spine stays. Of medics I know, I trust about 10% of them to make a rule in/rule out decision on c-spine based on the actual patient and their full presentation and not how the wind is blowing on a given day or how lazy they feel.

All the c-spine precaution decision matrices I've ever seen and feel comfortable with require immobilization for any core injury and for any patient with a severe distracting injury. There's no way somebody with a bullet through their head is going to be able to let you know if they have neck pain or lack light touch sensation.

 

[firecoins]

My understanding is that the injury was a through and through gunshot entering at the temple and exiting through the forehead. That seems to be a pretty well known path.

provided there is no airway issue, that would be a board and collar.

So, everyone who suffers a fall needs to be c-spined? Little 8 year old Suzie who trips playing at the park needs to be c-spined?

If the 8 year old was shot, I would highly consider it.

 

[EMS49393]

I realize this may not seem important to most people, but is there a reason why they couldn't throw a sheet or blanket over her? She's half naked in a crowd of people and it's January. Maybe it's because I'm a girl, but patient privacy is very important to me and I can toss a sheet on someone while I'm moving and without delaying any care.

Yeah, I know, bottom on the list of concerns for someone shot in the head, bash away.

 

[abckidsmom]

I realize this may not seem important to most people, but is there a reason why they couldn't throw a sheet or blanket over her? She's half naked in a crowd of people and it's January. Maybe it's because I'm a girl, but patient privacy is very important to me and I can toss a sheet on someone while I'm moving and without delaying any care.

Yeah, I know, bottom on the list of concerns for someone shot in the head, bash away.

In an MCI shooting, where I am just getting in and out with my red patient, I would like to have her covered, but am not going to be going back and forth to acheive it. Also, it's January in AZ, where it's not so cold.

 

[EMS49393]

In an MCI shooting, where I am just getting in and out with my red patient, I would like to have her covered, but am not going to be going back and forth to acheive it. Also, it's January in AZ, where it's not so cold.

Understandable, which is why I keep at least two flat sheets folded on my cot, so I won't have to run back and forth and I can cover up while I'm cutting off.

 

[JPINFV]

provided there is no airway issue, that would be a board and collar.

Would it be for any GSW to the head, or does the fact that it was through and through make a difference?

Results: A total of 215 patients were included in the study. Cervical spine clearance in 202 patients (93%) was determined either clinically, radiographically, or by review of postmortem results. No patients sustained indirect (blast or fall-related) spinal column injury. Three patients had direct spinal injury from bullet passage that were apparent from bullet trajectory. More intubation attempts occurred in patients with cervical spine immobilization (49 attempts in 34 patients with immobilization versus five attempts in four patients without cervical spine immobilization, p = 0.008).

Conclusions: Indirect spinal injury does not occur in patients with gunshot wounds to the head. Airway management was compromised by cervical spine immobilization. Protocols mandating cervical spine immobilization after a gunshot wound to the head are unnecessary and may complicate airway management.

http://journals.lww.com/jtrauma/Abs...ith_Gunshot_Wounds_to_the_Head_Do_Not.20.aspx

Results: One hundred seventy-four charts were available for review; 90 had C-spine radiographs (complete series [49], lateral [33], and computed tomographic scan [8]). Of 84 with no radiographs, 29 were clinically cleared, and 55 died (32 cleared at autopsy). Twenty-three died without evaluation. None of the remaining 151 (87%) had CSI. Literature search yielded only three relevant articles. Combining the data from these articles yielded 534 patients, and CSI was excluded in 507 (95%).

Conclusion: C-spine immobilization and diagnostic radiography are probably not necessary in patients with isolated GSWs to the head and may complicate and delay emergency airway management.

http://journals.lww.com/jtrauma/Abs...ury_Associated_with_Gunshot_Wounds_to.11.aspx

 

[abckidsmom]

Understandable, which is why I keep at least two flat sheets folded on my cot, so I won't have to run back and forth and I can cover up while I'm cutting off.

I can imagine that this was a ridiculously chaotic scene, and I'm willing to bet that the providers who ended up with this patient did not arrive at her side in the conventional manner, with their stretcher and their sheets. I can also imagine that the number of hands (aids and staff) putting her on the stretcher was insane.

These high-profile scenes are fast, fast moving and full of lots of people who, like that aid who the article was centered on, are jumping in and doing a job they don't really know what they're doing, or how they're helping or hindering the actual providers.

Don't get me wrong, this is great that people are jumping in, but it adds a whole 'nuther dimension to the scene management that they don't always address in MCI class.

Those "helpers" are best dealt with by giving them a task, because they just WON'T be shooed away, and they can become a PR nightmare if you just shoo them off.

So, yes. She should have had a sheet covering her, but notice that she wasn't completely naked (even though she technically should have been), and I don't see a pair of trained medics taking care of her. Would your partner have remembered a sheet if you were busy with 4 other things?

 

[firecoins]

Would it be for any GSW to the head, or does the fact that it was through and through make a difference?
]

No it would not make a difference. Body shots also get boarded.

Studied are nice. Like to see one larger one than 250 patients. I would still board and collar despite these studies.

 

[JPINFV]

No it would not make a difference. Body shots also get boarded.

Studied are nice. Like to see one larger one than 250 patients. I would still board and collar despite these studies.

Is there any evidence that isolated GSWs to the head causes spinal injuries?

 

[firecoins]

Is there any evidence that isolated GSWs to the head causes spinal injuries?

you mean other than patients shot in the head with spinal cord injuries?

 

[JPINFV]

So you've had a patient with a through and through wound that was no where near the spinal cord who suffered a confirmed spinal injury?

 

[firecoins]

So you've had a patient with a through and through wound that was no where near the spinal cord who suffered a confirmed spinal injury?

I have pts who were shot in the head with a spinal cord injury. It was not a through and through shot. post edit. I have never spent time on a scene examining the path of a bullet nor do I have time.

The trauma team can do whatever they want once the patient is theirs but they want the patient on a board and collar until x-rays are taken. Fine with me. thats my protocols.

 

[Veneficus]

Naked on the table

That is how acute trauma patients should appear.

It pains me to have to point out to pseudohealthcare providers that there is absolutely nothing more or less special about the body or any part of it.

In the acute phase of an emergent trauma victim, providers do not have the benefit of omniscience need to be able to fully assess the victim. It requires complete visualization and exploration.

There is absolutely no way for a field provider to know that there were not multiple injuries without a complete exam. From the picture I would say they left far more intact than I would have considering the nature of the event.

Whats more, there is a medical necessity to be able to constantly observe the patient over time. Especially in trauma, if you start noticing electronic gadget changes prior to physical changes, you may be hopelessly behind the curve. In the absence of medical imaging, physical findings are the only findings.

A distending abdomen, tracheal deviation, bleeding from the urogential/rectal orifices, paradoxical chest movement, brusing, etc, are essential findings that can be obscured which may have a definitive impact on the outcome.

The goal is to save a life and preserve function, not modesty. There is little value or use in a modest dead person.

There was no way prior to a proper exam to know she was only shot in the head. With all the blood likely around and the screaming pandemonium, tracing bullet tracts is not part of EMS response.

As for the collar and board, I wouldn't have bothered. if the cord is severed by a high velocity projectile, immoblization will do little for it. If only the vertebrae were involved the natural splinting will take care of it. The soft cot will also allow parspinal compartment expansion for the inevitable inflammatory response or bleeding into the compartment.

(Don't forget I am not your medical director, so follow your appropriate standing orders)

If you are really still concerned about modesty, rather than wonder about the medics who appropriately didn't use a sheet, perhaps you could be more concerned with the agency that published the picture.

I won't dispute that it is the role of the media to record and report, the quest for a sensational story should taake into account the suffering of the victims.

I have never seen a rape victim's photos published, why should a gunshot victim be afforded less courtesy?

In classical Greek theatre, sensationalism is never acted on stage. The story is reported on stage and never acted or portrayed. Perhaps there is a lesson to be learned there?

(I suffer from broad spectrum intelligence and in addition to having actually enjoyed all of those required educational requirements not directly related to my focus, I actually seek them out for the indirect benefits afforded from pulling informtion from multiple applicable disciplines. It is a curse I know.)

 

[Shishkabob]

Honestly, in an MCI where I'm first on scene, a patients modesty is the least of my concern--- all patients living longer is higher up.

In the auto accident I worked last weekend with 1 dead and 8 wounded, the first person to get a sheet was the deceased.





As for C-spine/backboard, we can clear c-spine, but one of the limiting factors is distracting injuries. Being shot in the head is pretty distracting...