would you c-spine?

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Anonymous

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Mid 70s. Mechanical slip and fall. Pain 10/10 to low back/butt. No neck pain. Ambulatory prior to calling but after 1 hour and a vicodin patient is now unable to walk due to pain. Good PMS. Patient sitting on couch. Vitals WNL and alert and oriented.

Anything else just ask.
 
Anonymous said:
Mid 70s. Mechanical slip and fall. Pain 10/10 to low back/butt. No neck pain. Ambulatory prior to calling but after 1 hour and a vicodin patient is now unable to walk due to pain. Good PMS. Patient sitting on couch. Vitals WNL and alert and oriented.

Anything else just ask.
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Was the fall witnessed? Is the pt a reliable historian?
Either way the pt is probably getting transport in a position of comfort(or as close to it as you can get)
 
Patient was able to answer questions appropriately and fall was witnessed. Leaning on a chair and the chair slipped out, causing pt to lose balance and fall.
 
No board. Transport in the position of least discomfort.
 
That is what was done, flatted out. No way hard board would have been tolerated. Got flack from the ED that is why I ask.
 
Give flac back. "She wouldn't tolerate, boarding would make it worse"

At first, do no harm.
 
Milla3P said:
Give flac back. "She wouldn't tolerate, boarding would make it worse"

At first, do no harm.
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I'd correct that to do least amount of harm. We do harm with many procedures, but it's supposed to be overall best for them because of condition.

I think this scenario has more to do on whether a board is needed to prevent a worse injury, rather than comfort/toleration (since the ER COULD argue that making him tolerate some pain which could be medicated was better than a worse injuring occurring). Unless of course, he was not tolerating it so badly that he was moving more (like drunk patients).
 
I love when people C spine after the patient has already been ambulatory for an extended period of time.
 
ChaseZ33 said:
I love when people C spine after the patient has already been ambulatory for an extended period of time.
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But sometimes it comes down to the dreaded protocol thing...ours was ANY GLF...C-spine and Backboard ;)
 
Martyn said:
But sometimes it comes down to the dreaded protocol thing...ours was ANY GLF...C-spine and Backboard ;)
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That's unfortunate.

I'm not a fan of boarding people but mechanism alone is a crappy reason.

Random thought about c-spine, I had a guy the other day fall *** over teakettle off his bicycle into a construction trench. Probably the first "legit" backboarding I have ever done. +LOC, +ETOH, - neck pain, - motor but "burning" sensory intact, no abnormalities noted on palpation. Guy ended up having a SCI at C4-5 and is a quad now. You've got to take the whole picture into account.
 
ChaseZ33 said:
I love when people C spine after the patient has already been ambulatory for an extended period of time.
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Playing devil's advocate here but if your assessment revealed point tenderness, numbness and tingling in the extremities, and an obvious deformity over the cervical spine, would you still not spinal someone if they were walking around?

I agree that most spinals are unneeded especially if the patient is ambulatory on arrival, but the decision to spinal someone needs to be done via an assessment.
 
Anonymous said:
Mid 70s. Mechanical slip and fall. Pain 10/10 to low back/butt. No neck pain. Ambulatory prior to calling but after 1 hour and a vicodin patient is now unable to walk due to pain. Good PMS. Patient sitting on couch. Vitals WNL and alert and oriented.

Anything else just ask.
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Yup would get the board and padding.

Think about the MOI and the force of energy transfer. PT fell on butt where is the energy going to travel? It is going to go up his spine. Possible (unlikely) spinal injury further up the spinal column as a result of transfer of energy. Injury more likely if pt had sever curve in spine (i.e. looking down) or kyphosis. What if pt had prior back injury? Could definately reagravate it. Most likely this is why you got some flack from the ER.

Pt would be c-spine and backboarded. Heavy padding. Of course, our hospitals clear pts. off of backboards quickly.
 
leoemt said:
Yup would get the board and padding.

Think about the MOI and the force of energy transfer. PT fell on butt where is the energy going to travel? It is going to go up his spine. Possible (unlikely) spinal injury further up the spinal column as a result of transfer of energy. Injury more likely if pt had sever curve in spine (i.e. looking down) or kyphosis. What if pt had prior back injury? Could definately reagravate it. Most likely this is why you got some flack from the ER.

Pt would be c-spine and backboarded. Heavy padding. Of course, our hospitals clear pts. off of backboards quickly.
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Assess your patient.
 
leoemt said:
What if pt had prior back injury? Could definately reagravate it.
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What kind of back injury? So if your patient previously strained their back then slipped and fell and complained of back pain you are going to backboard them?
 
c-spine-clearance.pdf
 
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