Spinal Immobilization and Combative patients (with a scenario)

Refusal by action, like you arrive and the patient is gone, locked the door, runs away from you, ect.

In my experience when an altered person does this sort of thing, the door gets forcefully opened, and/or PD gets involved in "convincing" him to go to the ED.
 
In my experience when an altered person does this sort of thing, the door gets forcefully opened, and/or PD gets involved in "convincing" him to go to the ED.

i didnt say the person was altered...thats a whole other can o worms

ive had people of sound mind and body refuse to sign the RMA, but then lock the door, run away, or call 911 then decide to drive themselves without telling us.
 
ive had people of sound mind and body refuse to sign the RMA, but then lock the door, run away, or call 911 then decide to drive themselves without telling us.

That is a win.
 
Sounds Good.

Espically if the PD is requesting for him to go. Did you already contact the ER? Otherwise, good job.
 
Always weigh how still and calm the patient will be unrestrained vs. fighting to put them on a backboard, and having them fight to take it off after it's applied.

You didn't do a bad thing in my book. Just document things well.
 
Always weigh how still and calm the patient will be unrestrained vs. fighting to put them on a backboard, and having them fight to take it off after it's applied.

You didn't do a bad thing in my book. Just document things well.

when i was in the ER one day i was talking to a doc about this. there was an elderly pt. who was also heavily intoxicated with a collar o but it was around her face obviously not doing much good and i asked if i should take it off and he kept telling me know not till he got his x-rays back and the pt. insisted she would calm down and sit still with it off it was just irritating her because every time i put it back in place it slid back up. she needed a "no-chin" collar instead of a "no-neck" haha
 
I've been in this situation and called in online med control CYA. That is the only possible thing I would have done differently.
 
Just a student, but honestly I wouldn't sweat it. That's one of those situations where the diverge between the book and real life comes into play. I don't know how your system is, but in mine we board if there is a significant mechanism (i.e. mva) or if the patient complains of head/neck/back trauma or pain; however for, say, a simple fall denying loss of consciousness, hitting the head/neck/back or any pain there, I don't board and collar them. Despite this rule, though, I've had plenty of patients that either didn't want the board or that couldn't or wouldn't have tolerated it. Just do your best and document the hell out of it.

One example I can think of was an elderly patient who fell while outside his house working his house (guy used a walker to get around but didn't have it outside with him) who'd been overcome by the wind and fell against the house hitting his head, had a pretty good gash from it. It was FREEZING outside and raining to boot, and the guy didn't sound like he wanted to come with us. So I walked the patient inside because I'm not going to sit out there watching him freeze and getting him inside and out of the cold where I could assess him was more important than the board. Guy ended up refusing transport despite my best efforts.

Oh, but a little tip one of my classmates shared with me for restraining an intoxicated or otherwise altered patient on an LSB (this is more for physical restraint of a violent patient that you NEED to restrain for your own safety) is to turn the buckles upside of the board/cot upside down. Apparently when the button's not facing up it confuses the hell out of them trying to figure out how to get the belts off.
 
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