Spinal Precautions

[medichopeful]

I have a quick question,

Is there any harm in putting a person with suspected spine injury onto a backboard before applying a cervical collar? This is for a trauma assessment, so the steps would go something like this (this only includes relevant parts):

1) sticky test
2) roll patient onto side
3) do rapid assessment of neck, back (during the sticky test, so you can get it done and out of the way)
4) place patient on backboard when rolling to supine position(not secured)
5) apply cervical collar
6) secure patient to backboard

We have not gone over backboarding yet, but I would like to know.

Thanks!
Eric

 

[Shishkabob]

One, why would you be able to do the board before the collar?

And two, the properly sized collar helps the neck move even less while doing the roll.

 

[Sasha]

What's the sticky test?

 

[Lifeguards For Life]

why would one want to place a patient on a backboard, before application of a collar?

 

[triemal04]

Hey look! An actual answer to the question!

Is there harm? No. Is it acceptable in reality? Yes. Is putting a collar on first better? Yes. Does this mean it's acceptable to your proctor? Probably; as long as manual stabilization is held then you shouldn't have a problem; ask them if all you are worried about is testing.

There will be situations you come across where you will not initially be able to apply a c-collar right away; often times in that type of situation it's more appropriate to place the person straight onto a backboard.

That what you wanted?

 

[Hollywood]

Is the patient down or ambulatory when you AOS?

If the the Pt id down when you arrive, you immediately assess LOC, Whether they have a pulse and respirations. Then move to your RTA start at the head looking for DCAP-BLS-TIC.
Move to the neck, check for DCAP-BLS-TIC, JVD, and make sure the trachea is midline, also reach back and check for step down or spinal deformity on the back of the neck. Next step put your collar on and continue with the rest of your assessment checking the posterior last as your roll to transfer to a long board. Also some should if at all possible be holding C-Spine until the Pt's head is secured to the board.

DCAP-BLS-TIC= Deformities, Contusions, Abrasions, Penetrations, Burns, Lacerations, Swelling, Tenderness, Instability, Crepitus. Just a handy pneumonic I was taught in case anyone was wondering what it was.

 

[Lifeguards For Life]

Hey look! An actual answer to the question!

Is there harm? No. Is it acceptable in reality? Yes. Is putting a collar on first better? Yes. Does this mean it's acceptable to your proctor? Probably; as long as manual stabilization is held then you shouldn't have a problem; ask them if all you are worried about is testing.

There will be situations you come across where you will not initially be able to apply a c-collar right away; often times in that type of situation it's more appropriate to place the person straight onto a backboard.

That what you wanted?

i disagree.
can you give me an example of a situation in which you would have ample room and resources to place a patient on a board which would prohibit initial application of a collar?
by placing a collar after boarding a patient, i would say there is an increased potential to further any injuries. Is it acceptable in the field? could be. Is it acceptable to a procotor in a testin situation? best have a darn good reason or else they will believe you forgot, and only remembered to apply a collar too late in the scenario.

 

[medichopeful]

One, why would you be able to do the board before the collar?

And two, the properly sized collar helps the neck move even less while doing the roll.

Here is what I was thinking. If you do the log roll without a collar on, you would be able to actually look at the neck. Before you rolled the patient back, you would put the backboard underneath so that you wouldn't have to do any unnecessary rolling. After they were rolled back to a supine position, they would be laying on the spine board, but they would not be secured or have a collar on. When they were just laying on the backboard, I was thinking that you could put on a cervical collar, and then secure them to the backboard.

When I say put them on the backboard, I do NOT mean strap them down. Just lay them there.

What's the sticky test?

I'm sure it goes by other names as well. For us, a sticky test is a VERY rapid assessment looking for leaking bodily fluids (blood, etc).

why would one want to place a patient on a backboard, before application of a collar?

I should have been more clear in the original post, but they would just be laying on the backboard. They would not be secured.

Hey look! An actual answer to the question!

Is there harm? No. Is it acceptable in reality? Yes. Is putting a collar on first better? Yes. Does this mean it's acceptable to your proctor? Probably; as long as manual stabilization is held then you shouldn't have a problem; ask them if all you are worried about is testing.

There will be situations you come across where you will not initially be able to apply a c-collar right away; often times in that type of situation it's more appropriate to place the person straight onto a backboard.

That what you wanted?

Yep, that's what I wanted.

However, I am not JUST worried about testing. I would also like to know so I can do what's best for the patient.

Is the patient down or ambulatory when you AOS?

If the the Pt id down when you arrive, you immediately assess LOC, Whether they have a pulse and respirations. Then move to your RTA start at the head looking for DCAP-BLS-TIC.
Move to the neck, check for DCAP-BLS-TIC, JVD, and make sure the trachea is midline, also reach back and check for step down or spinal deformity on the back of the neck. Next step put your collar on and continue with the rest of your assessment checking the posterior last as your roll to transfer to a long board. Also some should if at all possible be holding C-Spine until the Pt's head is secured to the board.

DCAP-BLS-TIC= Deformities, Contusions, Abrasions, Penetrations, Burns, Lacerations, Swelling, Tenderness, Instability, Crepitus. Just a handy pneumonic I was taught in case anyone was wondering what it was.

For this case, I am thinking that they are laying down. I know you could just reach back and feel the neck, but I was thinking that it would be better to actually SEE the neck.

As far as DCAP-BLS-TIC, I've never heard that. I was taught DCAP-BTLS: deformities, contusions, abrasion, pokes/punctures, burns, tenderness, lacerations, swelling.

Thanks for the help everybody. Any other feedback is appreciated.

 

[medichopeful]

Clarification

For this scenario, I am talking about just placing them on the backboard. I am NOT talking about securing them and THEN putting the collar on.

 

[triemal04]

i disagree.
can you give me an example of a situation in which you would have ample room and resources to place a patient on a board which would prohibit initial application of a collar?
by placing a collar after boarding a patient, i would say there is an increased potential to further any injuries. Is it acceptable in the field? could be. Is it acceptable to a procotor in a testin situation? best have a darn good reason or else they will believe you forgot, and only remembered to apply a collar too late in the scenario.

Sure. The pt's prone (facedown)...on their side (not always but depending on the pt's anatomy and specific position)...it's not a common thing, but it does happen. Far as increased risk of injury...not a whole lot when done correctly, just like a lot of what we do.

Far as testing...depends on the proctor, but technically, according to the national skill sheets, as long as manual stabilization is held it's ok; that "technically" mind you, so it'd be best to ask first.

 

[Lifeguards For Life]

Here is what I was thinking. If you do the log roll without a collar on, you would be able to actually look at the neck. Before you rolled the patient back, you would put the backboard underneath so that you wouldn't have to do any unnecessary rolling. After they were rolled back to a supine position, they would be laying on the spine board, but they would not be secured or have a collar on. When they were just laying on the backboard, I was thinking that you could put on a cervical.

you don't necessarily need to look. you can feel behind there right before application of the collar.
It is best to err on the side of the patient. If you felt or saw anything that in your eyes confirmed a c-spine injury, would you treat the patient very differently that a patient who just likely has a cspine injury?

 

[medichopeful]

you don't necessarily need to look. you can feel behind there right before application of the collar.
It is best to err on the side of the patient. If you felt or saw anything that in your eyes confirmed a c-spine injury, would you treat the patient very differently that a patient who just likely has a cspine injury?

I would not, but 2 senses are better than one, correct?

 

[Sasha]

you don't necessarily need to look. you can feel behind there right before application of the collar.
It is best to err on the side of the patient. If you felt or saw anything that in your eyes confirmed a c-spine injury, would you treat the patient very differently that a patient who just likely has a cspine injury?

It's still worth noting.. You can't feel a bruising, but that would be something worth noting in your report.

 

[Lifeguards For Life]

I would not, but 2 senses are better than one, correct?

you are correct, multiple sources of information are better than one. What it comes down to though, is to you, is gaining that additional piece of information(which will not alter your care of the patient) worth the possibility of aggravating a spinal injury?

 

[triemal04]

you are correct, multiple sources of information are better than one. What it comes down to though, is to you, is gaining that additional piece of information(which will not alter your care of the patient) worth the possibility of aggravating a spinal injury?

How much extra movement do you think that a c-collar really prevents versus only holding manual stabilization? Think about HOW a collar prevents movement in the spine, and then HOW manual stabilization is held when rolling a pt. Really, if it did such a great job, then there would be no need to even hold on once a collar was on; you could just let go. Don't make this out to be such a danerous thing; it's not.

 

[medichopeful]

you are correct, multiple sources of information are better than one. What it comes down to though, is to you, is gaining that additional piece of information(which will not alter your care of the patient) worth the possibility of aggravating a spinal injury?

Good points.

 

[Lifeguards For Life]

How much extra movement do you think that a c-collar really prevents versus only holding manual stabilization? Think about HOW a collar prevents movement in the spine, and then HOW manual stabilization is held when rolling a pt. Really, if it did such a great job, then there would be no need to even hold on once a collar was on; you could just let go. Don't make this out to be such a danerous thing; it's not.

sorry. i'm not trying to say that this is definitively dangerous. From my experiences, i would not count on a provider manually holding c-spine alone. I still can not think of a good scenario that would warrant delayed application of a collar, that also allows rapid application of a backboard.

 

[triemal04]

sorry. i'm not trying to say that this is definitively dangerous. From my experiences, i would not count on a provider manually holding c-spine alone. I still can not think of a good scenario that would warrant delayed application of a collar, that also allows rapid application of a backboard.

Sure. The pt's prone (facedown)...on their side (not always but depending on the pt's anatomy and specific position)...it's not a common thing, but it does happen. Far as increased risk of injury...not a whole lot when done correctly, just like a lot of what we do.

So...how many times have you placed a c-collar on a person who's face down? People don't end up lying face-up completely straight in a large, open room like happens in the classroom. It'll happen. To not bed ready because you can't think of a situation when it'd happen...bad idea.

 

[Shishkabob]

When doing the rapid traime assessment, you should be palpatong the back of the neck for deformities and/or bleeding anyhow, so unless you have a reasonable reason to look, ie it feels weird or there's blood on your glove, or even more so, they complain of pain or tenderness indicitive of bruising or an injury there's probably not much reason to risk a look.

Most c-collars I've seen have a "window" in the back for inspection anyhow.

 

[medichopeful]

Sorry I abandoned this thread.

I talked to my instructor, and this is what he said. He said that if it is a significant MOI, apply the collar BEFORE doing the log roll. If not, you can roll them without a collar.

I think if you're not sure, it would be better to apply the collar.