geri-ground level fall

[FL_Medic]

NEXUS criteria do not apply to the elderly for exactly this reason. The Canadian C-Spine Rule specifically excludes patients over the age of 65, and NEXUS has not been validated in this population and therefore does not apply. They are at very high risk for fracture despite minimal mechanism of injury, have underlying bone disease such as osteoarthritis, lack much of the supporting musculature that younger patients have, and frequently perceive pain differently from younger patients. Physical exam alone in geriatric patients, for a whole variety of conditions, is notoriously unreliable.

I have had dozens of elderly patients with c-spine fractures from ground level falls. I've found several c-spine fractures on elderly folks that were days or weeks old. Even in unstable fractures from these falls, neurological symptoms have not been present in many.

This is one of those situations where you really do need to immobilize them, regardless of what your gut says. You can take the compassionate approach to c-spine with a c-collar and scoop or a c-collar and securing well to the cot, but you have to treat for this injury.

'zilla

Where's the evidence that advocates spinal immobilization? There is no evidence that shows our methods of spinal immobilization does anything to protect even a known injury to the cervical spine. I hear what you're saying, and I have read it all too. However there is more evidence showing that you will further injure a patient using our traditional methods. Of coarse, I'm not ready to sit on the stand and defend that stance until my MD is ready to accept the data. Just thought I'd play devil's advocate.

[HellsBells]

FL medic, can you share the source of that data? I'd be interested in reading it.

[usmc_chris]

Doczilla,

I definitely agree with what you're saying - immobilize, but use an alternative method. Is there any system where this would be considered acceptable? Within my regional protocols, once a c-collar has been applied, you MUST use a long back board - there is no "alternative" immobilization permitted. I "might" be able to get away with using a c-collar and a scoop stretcher to secure the spine. I would love to be permitted to do exactly what you describe for elderly patients with a potential for a c-spine injury but no major indicators (obvious trauma, pain to spine, etc would still get the "works") - the only reason they get immobilized is I can't use our selective spinal immobilization protocol due to their age. Is there any way anybody here can think of to get this to be permissible? Thanks