Who's still routinely c-spining?

Tigger

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Great Video, That would be great video for EMT training. But I am sure that some do.:rofl:

Please, please proofread your posts. We're far from grammar nazis here, but a lot of us are having trouble understanding what you're trying to say in a lot of your posts.
 

Medic Tim

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Some do what?


Teach that mechanism of injury is more important than assessment finding and that unproven old practices save lives and litigation even though evidence suggests otherwise ..... Just a guess.
 

Handsome Robb

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GoldcrossEMTBasic - when I wrecked my snowmobile in the beginning of December I had extreme midline and perispinal low cervical and high thoracic pain. Also, deformities were present. I partially separated my C6, C7, T1 and T2 costovertebral joints from my spinal column.

When I laid down the pain was even worse and to the point where I couldn't actually breathe. That was laying in the snow. I couldn't even imagine a hard plastic board, there's no way I would've consented to spinal motion restriction. They'd have had to RSI me if they wanted me on a board that badly.

I'm still walking.

In HS I subluxed my c2-c3 and also rotated both of them playing football which resulted in a spinal cord impingement and temporary neuro deficits. I wasn't boarded then either.

Still walking.

Moral of the story, the stories they tell you in school are often to scare you. The patients they talk about losing neuro function would've lost it board or otherwise. Add swelling to a basically enclosed space and there's no where for that pressure to go. Eventually it will impinge on the cord and cause temporary or permanent neuro deficits.
 

medicsb

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I'm guessing he's not mentioning some inclusion and exclusion criteria that would probably get things pretty close to NEXUS, which is certainly validated.

If he is actually using NEXUS, then conversation over. The criteria he stated is alarmingly narrow, so I hope it's actually a (unintended) deception or partial truth.

Moreover, I think it may be a little optimistic to think that the neuro assessments done in NEXUS (or the Canadian studies) were OSCE-style. (Not a lot of tuning forks in most ED labcoats...) Nor do I think it would necessarily be for the better. I liked the TBI study where they had neurologists examine everyone in the ER lobby and found something like 10% with asymptomatic deficits. Predictive value and all that...

I'd imagine that they were not at all OSCE style and probably quite rudimentary (I'll have to go track down the studies to see if they mention what the neuro exam consisted of). But, I'd say the NEXUS makes up for a rudimentary exam by considering other factors.

I would expect that the majority of at-risk patients with chronic issues, such as neuropathic diabetics, would be ruled-in by most providers unless it was abundantly clear there was no change from their baseline (probably impossible to say in most cases; in fact, by the spirit of NEXUS this would probably qualify as a condition preventing assessment, similar to inebriation or a distracting injury).

I agree.
 

Brandon O

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I'd imagine that they were not at all OSCE style and probably quite rudimentary (I'll have to go track down the studies to see if they mention what the neuro exam consisted of).

As I recall they don't specify the contents of the neuro exam. One presumes the usual standard of care. But I drink heavily and could be wrong.
 
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FiremanMike

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I'll admit I had to look up "NEXUS" because in my 16 years practicing and 10 years teaching, I'd never actually heard that term. What I found was the basic c-spine rule out exam that's been taught as long as I can remember.
 
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NomadicMedic

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In the majority of programs, EMTs are not taught any C-spine rule out and continue to put ANY fender bender victim on a board.

In fact, one of the EMS instructors here was advocating that BLS keep putting accident victims on a board because "we don't carry an x-ray or MRI on the ambulance"

FACE. PALM.

Congratulations that you've been proactive keeping people off boards as long as you have.

... And 15lpm on an NRB goes great with that board and collar. Because, OXYGEN.
 
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jrm818

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As I recall they don't specify the contents of the neuro exam. One presumes the usual standard of care. But I drink heavily and could be wrong.

Drinking slightly more lightly but I think you're right...I think such details are explicitly ommitted, as are details about what constitutes a distracting injury. Ive heard Dr Hoffman ( not personally...panel sessions from the all LA conference for em residents used to be posted publically) be very emphatic that nexus is a decision aid not decision maker and depends on clinical judgement.
 
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Brandon O

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I'll admit I had to look up "NEXUS" because in my 16 years practicing and 10 years teaching, I'd never actually heard that term. What I found was the basic c-spine rule out exam that's been taught as long as I can remember.

Well, that's where it came from. Are you guys using similar criteria -- i.e. patient can't be altered, no major distracting injuries, etc?
 

jrm818

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In the majority of programs, EMTs are not taught any C-spine rule out and continue to put ANY fender bender victim on a board.

In fact, one of the EMS instructors here was advocating that BLS keep putting accident victims on a board because "we don't carry an x-ray or MRI on the ambulance"

FACE. PALM.

Congratulations that you've been proactive keeping people off boards as long as you have.

... And 15lpm on an NRB goes great with that board and collar. Because, OXYGEN.

Agree..and .even for physicians nexus was important probably more because it officially gave evidence based permission to practice the way most knew was right without as much fear of unfair liability


And sorry can't figure out multiquote...but in reference to no one in particular....I never again want to hear criticism of requirements in health science programs for things like general English classes or any analytical liberal art subject for that matter. The value of suchgeneral eduxarion classes even in seemingly unrelated programs should be immediately apparent to anyone perusing this thread...
 

Handsome Robb

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JRM for multiquote click the button next to quote on the posts you want to multiquote then once you've selected them when you get to the last post you want to quote click the actual quote button.

:)

NEXUS and CCSR originally were developed to decide whether or not imaging was indicated.
 
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FiremanMike

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Heh, I just remembered an IFT I was involved in. Trauma patient being transferred from outlying to a trauma center, isolated extremity injury, etoh on board. Patient had already been removed from the backboard, c-collar, c-spine X-rays were already done and negative. Sending physician demands we place the patient back in full spinal immobilization prior to transport. I diplomatically suggested this may be unnecessary, but he wasn't hearing it.. Patient was placed back on a board with a new collar..
 

Tigger

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Did a standing take down just now. I feel dirty, need a shower right quick.

Slowly I work for change but obviously it takes a long while.
 

Handsome Robb

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Heh, I just remembered an IFT I was involved in. Trauma patient being transferred from outlying to a trauma center, isolated extremity injury, etoh on board. Patient had already been removed from the backboard, c-collar, c-spine X-rays were already done and negative. Sending physician demands we place the patient back in full spinal immobilization prior to transport. I diplomatically suggested this may be unnecessary, but he wasn't hearing it.. Patient was placed back on a board with a new collar..

The patient consented to that?

There is the possibility of a SCIWORA but not super common, especially without neuro deficits presenting.
 
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FiremanMike

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The patient consented to that?

There is the possibility of a SCIWORA but not super common, especially without neuro deficits presenting.

Patient had etoh on board.. I'll be honest I wasn't quick enough at the time to try and play the consent angle, but in retrospect the doctor would have just said "her lack of consent is invalid because of the alcohol"...
 

mycrofft

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Yeah, that's what I want. Someone subject to vomiting or becoming combative or claustrophobic, strapped down prone on a hard board on my ambulance litter.
 

DrParasite

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Someone subject to vomiting or becoming combative or claustrophobic, strapped down prone on a hard board on my ambulance litter.
isn't that how you kill someone? positional asphyxiation and all that crap?

I wouldn't want to do that either. it might be detrimental to my career.
 
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