C-Spine and Failure

[Niftymedi911]

Is it better to C-spine someone who fell and is also symptomatically bradycardic with rales, hypotension and severe respiratory distress (which will lead to you intubating the patient. Or better to not c-spine, place the patient in high fowlers and treat accordingly?

I ran this call the other day, I've never ever had someone like this before. I went with the first choice, C-spine, High flow O2 NRB, IV, 12 lead (negative for STEMI), .5 mg of Atropine, placed pads and turned on pacer and started Dopamine ( pressure was 60/24). And I intubated the patient about 2 minutes later.

Which one would you all of chosen?

[Arizonaffcep]

Describe the fall? Ground level? Elevated? How old was the Pt? Pts? HX? All that can play a role in my choice to c-spine a Pt or not.

[Niftymedi911]

Mid 80 yr old Female, HX of HTN, CAD, COPD, right hip sx, and osteoporosis. It appeared that she was walking from her chair in the living room to her front door and fell onto the tile floor right in front of the door. Small lac to the right orbit and skin tears to bi-lat forearms. Found in prone position. + LOC.

[Arizonaffcep]

Ya...c-spine precautions would be called for.

[crotchitymedic1986]

In the absence of back pain, I would immobilize her sitting up in a KED.

[Arizonaffcep]

In the absence of back pain, I would immobilize her sitting up in a KED.

Except she was found in a prone position...KED not called for.

[crotchitymedic1986]

Doesnt matter what position she was found in, you can roll her on to KED just as easy as a backboard. If she has back pain, i would use a board, but I would not force her into heart failure and respiratory distress if she does not need spinal immobilization.

[crotchitymedic1986]

You also have to realize that less than 10% of all multi-trauma patients have C-Spine fractures, so the amount of patients who get c-spine injuries from ground level falls is significantly less. Obvioulsy, you have to use common sense if the patient has any signs or symptoms, a history of osteoporosis, neuro deficits, or even just a gut feeling you should immobilize. But immobilizing every one that trips over their own feet is ridiculous.

The more common problem that you should be concerned with is brain injury. The brain shrinks over your lifetime, which leaves more space between brain and bone, where blood can collect without presenting any symptoms because the brain is not being compressed. Any elderly patient who has a head injury should be transported, but not all need to be immobilized.

[Arizonaffcep]

She needs c-spine immobilization. She's 80 and fell and obviously struck her face...huge load on her neck. Part of the whole KED board thing is...once they are in a KED board, they then get secured to a LSB (long spine board), so you get the same thing. It'd just be easier to roll this patient to a LSB and secure that way, rather than take the 5-10 minutes to do all the extra steps with a KED board, considering her VS and LS.

[fiznat]

I agree with immobilizing the c-spine with a KED and placing the patient in an upright position. The issue here is the rales and SOB. We don't suffocate people on their own pulmonary edema so that we might protect a potential c-spine injury laying them flat on a LBB, that doesn't make sense. The KED + Collar will do a good job with the cervical area of the spine and allow us to focus on the airway as needed.

By the way why did you give a brady patient with a pressure of 60 atropine? Not trying to bust your balls here, just pointing out that ACLS says to go right to pacing.