Simple tricks

[el Murpharino]

So in my refresher class the other day, I heard of a pretty simple way to "pad the void" in the lower back when your patient is on a LBB - use the thigh BP cuff, slide it in while it's flat, and pump it up until your patient has relief. It's so simple I almost felt dumb not thinking of it myself at some point. Anyways, I figured I'd ask around and see if there were any other simple solutions people had to common problems like this. Thanks.

 

[skyemt]

BP cuff could leak under pressure of someone lying on it... if that matters to you...

why is it better than a towel or blanket?

 

[certguy]

Padding under the knees or , if possible , having the pt. bend thier knees also helps .

 

[BossyCow]

I'm not sure I would do this. The cuff could become unstable because of a leak or because someone accidently deflated it. I like a more stable material, like a towel. Also, on a less technical level, a bloody towel stays at the ER and is cleaned by the hospital laundry, the bloody BP cuff has to come back to the station in a biohazard bag and is cleaned by me.

 

[el Murpharino]

BP cuff could leak under pressure of someone lying on it... if that matters to you...

why is it better than a towel or blanket?

If you remember to put a towel or blanket under there when backboarding, it probably isn't any different, but if you're stuffing towels or a blanket underneath them while on the backboard, enough at least to provide relief, your patient will most likely end up shifting a bit one way or the other....defeating the purpose of total immobilization. I'm not saying inflate the BP cuff to it's maximum capacity; only enough to provide some relief. The thigh cuff is pretty durable...most of the lumbar support mechanisms on vehicle seats are essentially air bladders. It's not an 'always-use' mechanism anyways. As always, use some judgement.

 

[skyemt]

If you remember to put a towel or blanket under there when backboarding, it probably isn't any different, but if you're stuffing towels or a blanket underneath them while on the backboard, enough at least to provide relief, your patient will most likely end up shifting a bit one way or the other....defeating the purpose of total immobilization. I'm not saying inflate the BP cuff to it's maximum capacity; only enough to provide some relief. The thigh cuff is pretty durable...most of the lumbar support mechanisms on vehicle seats are essentially air bladders. It's not an 'always-use' mechanism anyways. As always, use some judgement.

as i'm sure you know from using bp cuffs... inflate one, and check back 5 minutes later... it will not have the same inflation... most of them will leak slightly over time... i just don't get why this is a better idea than a rolled blanket or towel... do you really want to keep checking the thing for leaks?

makes no sense to me. there are better alternatives.

 

[EMTBandit]

I would just rather stick to the good old towel or blanket. Hasn't failed me yet. It's a lot easier to deal with, easily replaceable, and gets thrown out. Using a cuff just sounds like more trouble than it's worth.

 

[el Murpharino]

skyemt, I think I answered why using towels or blankets could be detrimental to the patient. I'm not going to beat a dead horse. Again, I'm not saying the thigh cuff is going to maintain a constant pressure, or is the holy grail of backboarding management. But what it will do is provide some relief to someone on the LBB without having to shove something under them and invariably shifting them around and potentially worsening a spinal injury. I'm not going to defend whether or not a BP cuff is useful or not anymore; I have used it several times in the past with positive results. You can stick to stuffing towels or blankets under your patients. Towels and blankets are perfectly acceptable standard and I'm not questioning the tactics of such. That's not the point of this thread. It is to get other simple tips and tricks.

 

[skyemt]

simple tricks and tips implies that it is a better way than the tried and true way...

sorry, but as many on this thread have stated, yours does not seem to fit the bill...

however, no need to get defensive! to each his own.

 

[BossyCow]

Yep.. I'll stick with what works and the towels work. Of course, I suppose, using the thigh cuff may be better than inserting towels incorrectly and jarring the patient but done correctly towels work well. Besides it means I don't have to disinfect the thigh cuff.

Also, besides the tendency of them to leak, there's the very real possiblity that the cuff could be accidently deflated by someone going to take a pressure enroute and grabbing the wrong bulb. An inflated thigh cuff is unstable by its very nature.

Do you document on your report that the lower back was stabilized with a thigh cuff? From a liability standpoint, it sounds like a risk. You are using something for a purpose that it was not intended. Lawyers love that.

 

[Jolt]

Okay, I'll throw in a trick I've learned that probably everyone is aware of just so the topic can shift.

When you're working for one of the cheaper departments that likes towels instead of those fancy commercial headblocks, and you want to secure your patient's head to the board with tape, you can use one long piece of tape instead of two pieces of tape on the forehead and chin. You do this by putting the towel rolls inn place, and having someone lift the board. Then you stick part of the tape to the bottom of the board up near the forehead, tape across the forehead (make sure not to pull the patient's head with the tape), stick the tape to the bottom of the board, go diagonally across the bottom of the board, coming back up and taping across the chin, and finishing off the piece of tape by sticking it to the side of the board opposite where you started the part that goes across the chin.

Maybe it's stupid, but it seems to secure the head much better than the two pieces that we were taught to use in class.

STOP TALKING ABOUT THE THIGH CUFF ALREADY!

 

[skyemt]

ok... what happens if you need to make an adjustment by the neck, or across the head... you have to take the whole darned thing apart??

i just don't see that one either...

there is a reason that two separate straps are used, and it's the same reason two separate pieces of tape are used...

i'm all for tips and tricks... but why reinvent the wheel... i don't want to be going over and under boards when i can just simply go across... again... think about the adjustments you may have to make...

 

[omak42]

Going back to the bp cuff thing real quick....if you are that concerned about patient comfort, then perhaps your agency should look at investing in inflatable back rafts. They are real simple to use, you just throw it on the backboard, tape it down (comes with a strap of taped on the bottom of the raft), ope the valve, pump it up, then close the valve. They work surprisingly well. I work for a very rural agency and our transport times range from about 25 min to 2 and half hours. I have never had a problem with them deflating, and they conform to the patients whole body, so it doesnt only relieve the lower back.

 

[Jolt]

ok... what happens if you need to make an adjustment by the neck, or across the head... you have to take the whole darned thing apart??

i just don't see that one either...

there is a reason that two separate straps are used, and it's the same reason two separate pieces of tape are used...

i'm all for tips and tricks... but why reinvent the wheel... i don't want to be going over and under boards when i can just simply go across... again... think about the adjustments you may have to make...

That one piece of tape very easily becomes two pieces of tape with one quick cut from your trauma shears. You can grab another piece of tape after that if you have to make your adjustments.

 

[skyemt]

That one piece of tape very easily becomes two pieces of tape with one quick cut from your trauma shears. You can grab another piece of tape after that if you have to make your adjustments.

of course! i know that! so your simple trick involves me now needing trauma shears and more tape!!

so, so silly.... two pieces of tape never went wrong for anyone. no trauma shears needed!

simple tricks and tips???

 

[emtskibum]

That one piece of tape very easily becomes two pieces of tape with one quick cut from your trauma shears. You can grab another piece of tape after that if you have to make your adjustments.

who needs trauma shears to cut tape????

 

[el Murpharino]

Going back to the bp cuff thing real quick....if you are that concerned about patient comfort, then perhaps your agency should look at investing in inflatable back rafts. They are real simple to use, you just throw it on the backboard, tape it down (comes with a strap of taped on the bottom of the raft), ope the valve, pump it up, then close the valve. They work surprisingly well. I work for a very rural agency and our transport times range from about 25 min to 2 and half hours. I have never had a problem with them deflating, and they conform to the patients whole body, so it doesnt only relieve the lower back.

I've never heard of these things...but knowing the powers that be at my agency, they'd say "thanks, but no thanks". But it's a heckuva idea...if agencies actually made patient care and comfort a priority over the bottom line.

 

[omak42]

I've never heard of these things...but knowing the powers that be at my agency, they'd say "thanks, but no thanks". But it's a heckuva idea...if agencies actually made patient care and comfort a priority over the bottom line.

I would hope that all agencies would put the patient care and comfort over any other matter, since that is what we are here for.....but sadly, I know you are right. I did check briefly into them and the pump for the is about 8 dollars and the rafts themselves are about 18....but perhaps it would be something to mention to your officers....I would strongly suggest you try, especially if your transport times are anywhere close to ours....good luck

 

[Jolt]

of course! i know that! so your simple trick involves me now needing trauma shears and more tape!!

so, so silly.... two pieces of tape never went wrong for anyone. no trauma shears needed!

simple tricks and tips???

It went wrong for everyone in my EMT class at some point. Gloves and tape stick together really well, and my method doesn't involve touching the sticky side with a gloved hand.

We could keep doing this I guess. Let's just agree to disagree.

 

[JPINFV]

I've never heard of these things...but knowing the powers that be at my agency, they'd say "thanks, but no thanks". But it's a heckuva idea...if agencies actually made patient care and comfort a priority over the bottom line.

A company can't provide patient care if the company can't pay the bills. As much as the bottom line might suck at times, it is something that has to be taken into consideration.