Suffocation and C-spine precautions

[AnthonyM83]

VS-what?

It's one of those Canaaadian things....pfffft

[WolfmanHarris]

Is VSA (Vital Sign Absent) really not a term everyone is familiar with? Or am I getting the business and too dense to notice?

[AnthonyM83]

Yeah, I think it's a Canadian thing . . . (or at least not something I've heard in California).

My post was mainly poking fun at BEorP (and Canadians in general....the theme of the trip) who had to explain the term to me at the Cadaver lab last week.

[Doczilla]

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

This is one of those pieces of EMS dogma that gets passed down with this kind of emphatic dedication with absolutely no evidence to back it up. Not one reported case, EVER, of a patient having neurological deficit from improper c-spine precautions. And cases like this one are exactly why it is important for EMS providers to know what the real risks are, since management of the airway may be at odds with protection of the c-spine.

And a LOW c-spine fracture will not cause paralysis of the diaphragm unless there is substantial cord contusion at levels above the fracture. Dust, Anthony, BEorP, JakeEMTP, akroeze, and CBEMT can tell you this after the cadaver lab.

'zilla

[WolfmanHarris]

So seriously what are the chances that we'll see LSB and collars disappear under evidence based practice? I can't see how they could do a study on something like this that would pass an ethics board.

Unless... do wounded soldiers under fire get collared and boarded? Could that lead to research on immobilization for penetrating trauma?

Also physiologically speaking, what's different about splinting an extremity and splinting a spine that makes splinting the extremity a good idea and the spine an idea based on dubious science?

[BEorP]

Yeah, I think it's a Canadian thing . . . (or at least not something I've heard in California).

My post was mainly poking fun at BEorP (and Canadians in general....the theme of the trip) who had to explain the term to me at the Cadaver lab last week.

I also had to inform Anthony that snow is not just a Canadian thing (first I had to show him a map to explain that there are states other than California). But yes, Matt, VSA is a Canadian term it seems.

[JPINFV]

So seriously what are the chances that we'll see LSB and collars disappear under evidence based practice? I can't see how they could do a study on something like this that would pass an ethics board.

Unless... do wounded soldiers under fire get collared and boarded? Could that lead to research on immobilization for penetrating trauma?

Also physiologically speaking, what's different about splinting an extremity and splinting a spine that makes splinting the extremity a good idea and the spine an idea based on dubious science?

http://www.jems.com/news_and_articles/colu...ms_studies.html

Study number 1 comes as an example.

As far as the second part, you don't splint an extremity just because the person had a traumatic event like you do the spine. We splint limbs when we have reasons to believe it's fractured. We splint spines unless we are certain it's not fractured (e.g. the absence of a traumatic event).

[Dustdevil]

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.

[WolfmanHarris]

Very good point. I hadn't considered that for some reason.

Okay back to Doczilla on this one. So that I'm clear, the lack of instances of neurological damage due to improper C-spine immobilization is just for when they've been immobilized but it sucked or was done late or missed etc. This isn't saying that there isn't a possibility of secondary injury resulting in neurological damage after the initial spinal insult?

[Dustdevil]

I think we should put body armour on all gunshot victims to prevent secondary gunshot wounds too.