Suffocation and C-spine precautions

[WolfmanHarris]

So I was studying tonight and running some verbal scenarios from my case study book and came across this one.

16y/o VSA. Tied a housecoat belt around his neck and hung from own height as part of auto-erotic asphyxiation. When found his knees were on the ground and the belt had been padded when applied to the neck.

My thinking on mechanism for this one was that since the pressure would likely have been applied gradually by the person and the height isn't very high to begin with that c-spine injury isn't likely. So I chose to run the scenario without c-spine precautions.

Thought on this one? Was I right?

[CBEMT]

VS-what?

[Canadian Caesar]

VSA = Vital signs absent???

Of course I would suspect potential c-spine injury. You are talking about the application of significant forces in a manner that the spine was not meant to tolerate.

Even the gradual application of a few dozen pounds of force is more than enough to separate, twist, dislocate or otherwise injure the fragile cervical vertebrate.

[JPINFV]

VS-what?

VS-Eh?

[WolfmanHarris]

I'm still not convinced that the force is there. Part of this might be that the answer to the case study didn't call for it either and I've got some intertia here.

Here's the exact quote from the book:

"He was found with padding and a housecoat tie around his neck, hanging from a coat rack in his closet. His legs and knees were touching the ground ... Face is cyanosed with no ligature marks on his neck."

Does that make a difference for you?

[ERDoc]

I would err on the side of caution and immobilize.

[Canadian Caesar]

I am very glad you found such an interesting and valuable subject for discussion.

According to the following Medical journal article (The European Spine Journal) Eur Spine J (1995) 4:126-132:

Kinematics of cervical spine injury: A functional radiological hypothesis

L. Penning

Departments of Diagnostic Radiology and Neurosurgery, University Hospital of Groningen AZG, Groningen, The Netherlands

It only requires 8kg of Axial Traction on the cervical spine to cause a "Hangman's Fracture."

To put that force into terms you may have felt yourself, the relatively mild maximum 15lbs of force you use in the application of a traction splint to a femur fracture is enough to cause this type of fracture.

I myself have had 15lbs a la Sager splint to my bare ankle and had no ligature marks with that amount of force.

I would also hazard to guess that even with his knees on the ground, his total supported body weight results in more than a paltry 8kg of axial traction.

So unless the practitioner can somehow determine that this force was never applied, I would be uncomfortable ruling out C-spine involvement.

Who is to say that the patient did not slip and fall to his knees?

Or thrash about as his brain was slowly starved for oxygen?

Perhaps the noose was a half inch too short to allow his knees to rest on the floor, and the fact that they are now touching means he now has a half in gap in his vertebrate somewhere?

So with the best that my personal experience can offer me, as well as the information gleaned from various medical journals, I stand by my original position. This particular scenario presents a realistic chance of spinal injuries, and proper precautions are warranted.

[Dustdevil]

Plus 5 for some nice, relevant research, JP! :thumbright:

I agree that this is one of those scenarios that screams out for MOI immobilisation. The MOI strongly suggests the possibility. Patient is non-communicative, so you cannot rule out c-spine injury through SSI rules. And, of course, you can bet your instructors are specifically looking for the precautions.

Sure, chances are slim. You're more likely to need a trach than a c-collar. But the unfortunate fact is that there is no recognised, objective criteria available in an unconscious patient with which to rule out spinal injury.

[WelshMedic]

Nice relevant DUTCH research even.....

My feeling would also be to immobilize. The research just backs that up.

WM

[DwayneEMTP]

Actually, I'm impressed that they are making a decision here rather than simply saying "The neck was involved, so put on a collar." Lots of 'ifs' as to whether it is needed, but very little question that you're going to have a shitload of people crawling up your back on site and at the hospital if you don't.

Moot to me though, as if he's going with me he's getting a tube, to which I'll put on a collar anyway.

Ditto on the research.

Dwayne