emtfarva
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Here is a question that no one asked... did you say to the Pt that you might have to place the Pt on a LBB? If you did what did he say?
Selective c-spine - would you c-spine this patient
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Smash
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I synch cardiovert every patient with a heart rate above 100. I can't justify why I do it, but I just do. It's just how I roll.
emtfarva
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wouldn't it be above 150?I synch cardiovert every patient with a heart rate above 100. I can't justify why I do it, but I just do. It's just how I roll.
JPINFV
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...probably 100 just to be safe. You don't want to miss anything and get sued for not following the protocols afterall.
OP
OP
Epi-do
I see dead people
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I synch cardiovert every patient with a heart rate above 100. I can't justify why I do it, but I just do. It's just how I roll.
OP
OP
Epi-do
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I never said any such thing. I had no intentions of putting him on a backboard.
emtfarva
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Ahhh... funny...
JPINFV
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emtfarva
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ok... just wondering... I still would of boarded him just IMO
emtfarva
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I try is fine.I try. Or is it I'm trying. I always get those two mixed up.
But, as you might know being in Mass, a lot of people are sue happy in MA.
Smash
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Sorry, I was just being silly. No sensible, professional EMT or paramedic with at least half a brain would provide unecessary, uncomfortable, distressing and potentially dangerous treatments with no rationale, justification or basis in science would they...
denverfiremedic
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no c-spine.. If your going to for this guy you might as well do it for everyone that complains of a head ache .. if any further problems noted MAYBE
OP
OP
Epi-do
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Just some additional food for thought. I have spent the last couple days reading various studies, abstracts, etc, regarding EMS and boarding patients. There are plenty of them out there, and I would be happy to go back and get the links to the ones I read if anyone wants them.
There are those in EMS that use the thought that, "If I am not sure, I will board them because it doesn't hurt them if I do." That may not be the case.
Along with having to make sure a patient doesn't aspirate, there are other things to consider. One study I read, albiet a small study, found that spinal precautions cause a statistically significant raise in ICP. While this rise isn't large enough to be clinically significant for a healthy patient, what about the one with an undiagnosed anuerism, or some other similar medical condition?
On average, the boarded patient with no spinal injury spends an average of 1 hour on a backboard. There are several studies of healthy volunteers with no neck or back pain who agreed to be placed in full spinal precautions for the same period of time. One study found that after one hour, 80% of those volunteers reported significant pain at the end of one hour, which remained one hour after being removed from the board. A large number of those volunteers began complaining of pain after 30 minutes. Twenty-four hours after being removed from the board, up to 20% still had some degree of pain. Granted, with time, all volunteers became pain free again, but the fact that we were the ones who caused that pain seems to me to go against the idea of "doing no harm." Because these healthy, uninjured people had pain after a minimum of 30 minutes, how many of our patients are subjected to unnecessary radiological tests because they are positive for midline neck or back pain at the ER?
Further studies looked at pressure ulcers in patients who have been boarded. They found those who spent 2 or more hours flat on a board where more likely to have sacral pressure ulcers one week later, if hospitalized. It has also been found that soft tissue damage resulting in pressure ulcers can begin in as little as 30 minutes when laying on a flat, unpadded backboard.
So, by boarding patients that are candidates for not being backboarded are we really "not hurting them"?
There are those in EMS that use the thought that, "If I am not sure, I will board them because it doesn't hurt them if I do." That may not be the case.
Along with having to make sure a patient doesn't aspirate, there are other things to consider. One study I read, albiet a small study, found that spinal precautions cause a statistically significant raise in ICP. While this rise isn't large enough to be clinically significant for a healthy patient, what about the one with an undiagnosed anuerism, or some other similar medical condition?
On average, the boarded patient with no spinal injury spends an average of 1 hour on a backboard. There are several studies of healthy volunteers with no neck or back pain who agreed to be placed in full spinal precautions for the same period of time. One study found that after one hour, 80% of those volunteers reported significant pain at the end of one hour, which remained one hour after being removed from the board. A large number of those volunteers began complaining of pain after 30 minutes. Twenty-four hours after being removed from the board, up to 20% still had some degree of pain. Granted, with time, all volunteers became pain free again, but the fact that we were the ones who caused that pain seems to me to go against the idea of "doing no harm." Because these healthy, uninjured people had pain after a minimum of 30 minutes, how many of our patients are subjected to unnecessary radiological tests because they are positive for midline neck or back pain at the ER?
Further studies looked at pressure ulcers in patients who have been boarded. They found those who spent 2 or more hours flat on a board where more likely to have sacral pressure ulcers one week later, if hospitalized. It has also been found that soft tissue damage resulting in pressure ulcers can begin in as little as 30 minutes when laying on a flat, unpadded backboard.
So, by boarding patients that are candidates for not being backboarded are we really "not hurting them"?
very good points on C-spine not hurting someone.
also to the poster who stated that they couldn't clear c-spine due to the patient not speaking the same language: Epi's protocols state "the patient has to be able to understand you" be it patient is over 5 years old, or speak a language that you do.
also to the poster who stated that they couldn't clear c-spine due to the patient not speaking the same language: Epi's protocols state "the patient has to be able to understand you" be it patient is over 5 years old, or speak a language that you do.
redcrossemt
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What education do you need to do a spinal immobilization assessment, like indicated in NEXUS and many of our protocols? A little bit of anatomy, the able to ask the patient "does this hurt?", and the smarts to check off some boxes?
I would not have boarded this patient because I have a selective spinal immobilization protocol. I understand that some others do not have a similar protocol and must board patients with a MOI suggestive of any injury. However, as said many, many times before, those with selective protocols that board to CYA are just hurting their patients more.