Suffocation and C-spine precautions

[WolfmanHarris]

So either that meant no, or I screwed up what I was trying to say. So just in case, does this mean that the ole "I've fractured my spine at C2 but for the grace of god am still breathing and now whoops, moved wrong I'm dead." Is something of a myth? Or that the very least lacking clear grounding in research for how much we worry about it?

[Canadian Caesar]

I was on car with a Paramedic preceptor that recently returned from Australia where he went on multiple ride-alongs while on vacation.

He told me that at least one service there only used C-collars as spinal precautions because Long Spine Boards have no evidence to back their use. :shock: So I guess we are coming around slowly in the world of EMS.

[Arizonaffcep]

So either that meant no, or I screwed up what I was trying to say. So just in case, does this mean that the ole "I've fractured my spine at C2 but for the grace of god am still breathing and now whoops, moved wrong I'm dead." Is something of a myth? Or that the very least lacking clear grounding in research for how much we worry about it?

No...it's not a myth. It depends on where the fx is at...if the fx is a process fx (transverse or spinal) or even a Dens fx (the swivel point between C1 and C2)...as long as it doesn't impinge upon the spinal chord...you really won't see anything. Of course, what that "myth" is really referring to (I think) would be the equivalent of an unstable C2 fx. This is much less common than other types of fx's, where the disk integrity is compromised. Thankfully...doesn't happen too terribly often.

[Arizonaffcep]

I was on car with a Paramedic preceptor that recently returned from Australia where he went on multiple ride-alongs while on vacation.

He told me that at least one service there only used C-collars as spinal precautions because Long Spine Boards have no evidence to back their use. :shock: So I guess we are coming around slowly in the world of EMS.

I bet their lawyer to "joe public" ratio is much lower... :twisted:

[crotchitymedic1986]

I have always been cynical of whether or not back boards immobilize the spine any better than a mattress, especially when you consider that many medics tape or strap their patients to the board with the most minimal of equipment (3 LBB or stretcher straps), which means that every time the truck slams on brakes, there is axial loading to the spine and neck as the body shifts forward.

The backboard limits more damage to the spine as you transition them on and off the stretcher, but to claim that it actually immobilizes the spine is a stretch.

[mobey]

And, of course, in the case of a bone, we are attempting to maintain rigidity on something that is normally rigid. The spine is not normally rigid. We are, therefore, attempting to induce an unnatural state, contrary to the very principle of homeostasis.

However I do splint a femur to reduce vascular damage done by bone fragments/ends (compare vascular to cord) :wink:

Full spinal immobilization with a LBB is not something I am a fan of as there is no evidence, and the long transport times I have pressure sores are a real problem.

However in this scenario, I believe cervicle spine precautions were indicated. I don't really understand what you were saying on page 2 ERDoc, are you supporting the "cosmetic collar and board"?

I have a real problem with this cosmetic thang. If you do decide to take precautions, it should be done right from the get-go, not at the last minute just to appeal to the recieving Doc. Unless of course you say "No precautions were taken on scene, however they were once we loaded"

[firedoc5]

No...it's not a myth. It depends on where the fx is at...if the fx is a process fx (transverse or spinal) or even a Dens fx (the swivel point between C1 and C2)...as long as it doesn't impinge upon the spinal chord...you really won't see anything. Of course, what that "myth" is really referring to (I think) would be the equivalent of an unstable C2 fx. This is much less common than other types of fx's, where the disk integrity is compromised. Thankfully...doesn't happen too terribly often.

I can think of three instances off the top of my head that I have come across. Two from MVA's and one from a fall from a tree.

[CBEMT]

I have always been cynical of whether or not back boards immobilize the spine any better than a mattress, especially when you consider that many medics tape or strap their patients to the board with the most minimal of equipment (3 LBB or stretcher straps), which means that every time the truck slams on brakes, there is axial loading to the spine and neck as the body shifts forward.

Which is why the school I teach at instructs the use of two straps crossed over the shoulders. When done properly you can literally stand the board on the head end and the patient won't budge.

[NYC-EMS]

Your joking...right.If you walked in the ER with out one...it's a rap!!!!

[CBEMT]

Your joking...right.If you walked in the ER with out one...it's a rap!!!!

Which post are you referring to?