Suffocation and C-spine precautions

[defib_wizard]

In any hanging, the pts c-spine needs to be immobilized. But before you put a collar on the pt check his thyroid cartilage for crepitus. I suggest you have someone hold manual immobilization while you check the oral airway for trauma. If you are going to work him as a viable patient you don't want to be removing equipment that you just put on. ( C-collar ) Cricothyrotomy is a procedure that you will probably be performing on this pt. ( That was a lot of P's in 1 sentence LOL )

[fiznat]

Eh collar him, what the hell. You'll need a backboard under him to do good CPR, and a c-collar is nice to protect your tube. It doesn't cost you anything to take the extra half step and call him spinally immobilized.

That is assuming you're going to work this dude anyways....

[firedoc5]

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.

You beat me to that info, Julian. :wink: I wasn't on the call, but one of my best friend's ex-husband hung himself. At first they didn't know if it was suicide or trying to get the effects of the 16 yr. old in the scenario. With him they said he could still touch his toes, enough to let pressure off the neck at least. But they did deem it an "accidental suicide", but it must have been slow. And yes, C-2 was fx. They think he did try to stand on his toes, maybe hoping he could hold out until someone found him and "saved him". But he couldn't hold out and probably snapped his neck while trying to struggle to get free. There was evidence of trying to get his fingers under the rope around his neck, but the rope was already too tight and probably by that time asphyxiation would have made him too weak.

But I have been on several other hangings, and we always used C-spine immobilization. Almost anything involving the neck, C-spine precautions should be made.

[crotchitymedic1986]

The patient has no vital signs (I think) so this means he is in arrest. The text-book answer is that you should immobilize the c-spine and maintain the airway as you would any trauma arrest. Real life answer: cut him down, start ventilating and compressions. The c-spine fracture (that may or may not be there) is secondary to his airway issues which are there, if you want to throw him on a board and collar for cosmetic reasons, that is fine, but you have to save his life before you can worry about a possible fracture.

[WolfmanHarris]

Thanks for that journal reference. I seriously would not have believed that this amount of force would still present c-spine concerns. I'm having a heck of a time finding the full abstract on pubmed or elsewhere, so if you have a link to the abstract or even full text that would be fantastic!

Crotchity, I gotta disagree with you on this one. If there's an actual spinal issue it should be treated; not ahead of ABC's but still treated. With a crew of two (and tiered FD coming along behind me) if I can't multi-task the arrest and tossing a collar on, then that's a problem. CPR and defib are great, but this 16y/o will likely not be TOR'ed on scene (in my system) so I need to be thinking ahead to how I'm going to transport when the algorithm is finished and in that case I should board and do it right.

Anyways, I really appreciate the input on this one. Learned alot.

- Matt

[Arizonaffcep]

Thanks for that journal reference. I seriously would not have believed that this amount of force would still present c-spine concerns. I'm having a heck of a time finding the full abstract on pubmed or elsewhere, so if you have a link to the abstract or even full text that would be fantastic!

Only my 2 cents worth...but remember the direction of the force on the spine...the spine handles forces (A/P) quite well, laterally, not as well, compression even worse, but the PULL force on this spine, I believe is the most vulnerable. C-Spine precautions are absolutely called for here...as well as very aggressive airway management.

[mobey]

The patient has no vital signs (I think) so this means he is in arrest. The text-book answer is that you should immobilize the c-spine and maintain the airway as you would any trauma arrest. Real life answer: cut him down, start ventilating and compressions. The c-spine fracture (that may or may not be there) is secondary to his airway issues which are there, if you want to throw him on a board and collar for cosmetic reasons, that is fine, but you have to save his life before you can worry about a possible fracture.

K I had a big lengthy responce to this typed out but I lost it.

So my responce is this.

If he had a Fx in the lwr cervicle spine do you want to be the one responcible for severing the spine and ensuring he never breaths under his own power again?

SPINAL IMMOBILIZATION IS NOT LIFE OVER LIMB, IT IS LIFE OR DEATH

To my Canadian Co-workers. You guys are doing it right, asking a question then finding evidence to support you answer. That is what professional EMS is all about. I know you both are fairly new to EMS and I applaud you for "doin it right". My word of wisdom is this: Never listen to anyone who plays the "Textbook vs the street" card. A true independant medic will apply the textbook/science to the street, that is what seperates the pros from the monkeys (See monkerys in EMS thread).

[Dustdevil]

If he had a Fx in the lwr cervicle spine do you want to be the one responcible for severing the spine and ensuring he never breaths under his own power again?

Anatomy much?

[Canadian Caesar]

Thanks for that journal reference. I seriously would not have believed that this amount of force would still present c-spine concerns. I'm having a heck of a time finding the full abstract on pubmed or elsewhere, so if you have a link to the abstract or even full text that would be fantastic!

I had to use a separate Medical Journal search engine than PubMed. It's called Medline, one of the searchable databases via the University of Alberta website. I couldn't figure out how to make a hotlink work since the whole thing is password protected. :?

But I did manage to save the whole thing in PDF form so if you want it i would be happy to send it via E-mail.

I have a link if you have a system that gives you journal access like a University.

http://www.springerlink.com/content/t9w42636x03w77v7/

Just click the full PDF at the top of the abstract. The info you are looking for is in the description for Fig. 13 on page 6. It describes the force required for a Hangman's Type I fracture.

[WolfmanHarris]

I don't have access to my University account anymore. Can you PM me and I'll give you my e-mail to send it to. I'd love to read that article in full.