C-Spine and Failure

[Arizonaffcep]

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.

The head of the cot does raise up. Just got to pad under it. All of the directions I've ever seen for use of the KED board is to also place the Pt on an LSB.

[crotchitymedic1986]

There is no reason to lay this patient flat and drown her in her own fluids --- did you ever think that she might have lost consciousness due to the slow heart rate and poor oxygenation ? Even with the head raised a few degrees, she is still essentially flat -- You can immobilize her C-spine with KED and Collar, and let her sit up so she can breath too.

[fiznat]

You've transported patients on a LBB + tilted up on the stretcher? How did you secure them? They end up making a "triangle" (as viewed from the side) with the stretcher and slipping downwards. It isn't really safe or effective since you can't tilt anywhere close to the 90* necessary.

A KED + C-collar alone, in my opinion, does a fine job of stabilizing the c-spine for this kind of patient who requires a non-supine position.

[Niftymedi911]

Alright before you guys go jumping off the bridge..... relax, take a deep breath.

She had c/o of moderate back pain that was caused by the fall. Hence the c-spine with LSB and C-collar. The board was also @ about a 20 degree angle forming that "triangle", with the lip of it resting in the cradle at the end of the stretcher. And if you can READ correctly, she was given the atropine (I had a free hand), while my partner was putting the pads / pacer on and starting to obtain capture, as I had another medic with me in the back of the truck.

Crotchitymedic, BTW, I asked for an opinion, not a verbal thrashing. And I'm not an idiot. I would hope and assume that the hypotension and junctional rhythm she was in would of caused the LOC instead of a stroke. And in my eyes I did what was needed for the patient. And to be honest, there was nothing else I could do besides intubate her, she was so full of fluid to begin with. The use of CPAP was contraindicated becuase of the hypotension. And even if it wasn't I bet you 5 bucks and a wooden nickle the CPAP wouldn't of been enough. The pacing controlled the rate, but the Dopamine didn't even touch the hypotension, even after 20 min after I offloaded and was leaving and the pressure @ best was 74/42

[crotchitymedic1986]

I apologize if you read that as a thrashing, as it wasnt meant to be, and actually those comments werent even aimed at you. Be open to new suggestions, alot of EMS is grey, not black or white, and I have run this call both ways, and the KED is far superior. Doesnt make the other way wrong, just offering you a suggestion. Try it next time, and see what you think --- it is also good for the whales who can never lay flat because of stomach fat compressing the diaphram.

And check into the drug Dobutamine for CHF.

[Niftymedi911]

I appreiciate the suggestions. As that's what I was looking for. I guess I should be more open sometimes. -5 for me for being closed minded and not thinking outside the box like I normally do. The only thing about this call was the fact the FD already had her c-collared and backbaorded prior to my arrival. When I got there they told me she was a priority 3 back pain patient for the bandaid clinic. And meet me at the foot of the stairs as they were carrying her down the flight of stairs head down......... yea. And what's worse was there was a Fire-Medic on the rescue truck that supposedly did an "assessment".

Good ole Fire based oppression of EMS....

[Doczilla]

On the one hand, you have the theoretical risk of a spinal fracture, and the theoretical risk that not immobilizing it will do harm to the patient (never actually proven, though firmly in the dogma of prehospital and emergency medicine). On the other hand, you have evidence of compromise of airway and oxygenation, which if untreated, is always fatal.

I would immobilize sitting up, or forgo it altogether if it compromised oxygenating the patient.

'zilla

[AMESEMT]

I say it was a good call on immobilizing her. Her bones are fragile with her hx and the possibility of a fracture are higher. The KED board though..... By the sound of it she was unstable and spending the extra time to put her in a KED is not warranted.

Fiznat - According to ACLS pacing is necessary immediately, but atropine, epi, or dopamine can be used while waiting for the pacer. Since Nifty had help with the pacer I think it was a good call on the atropine and dopamine.

I have transported people on a LBB with the head of the cot up some to elevate the head. You just have to make sure you loosen the straps on the cot before you do it.

[defib_wizard]

It sounds like she would have been a perfect candidate for a full body vaccuum mattress. You can immobilize the pt in a semi-fowlers position. Then vaccuum all of the air out making it a custom fit to the pt.

The only problem with the ked is on some people even with the sides all of the way up into the armpits. The back of the ked will hang down past the pts buttocks. So you are suspending the pt from her armpits unless you pad the void under her butt and the mattress.