mobey Posted February 23, 2009 Posted February 23, 2009 Thanks Brent. That is just something to think about. Reality is... he is elderly and has a distracting injury, story changing - aside, I would still spinal him.
p3medic Posted February 23, 2009 Posted February 23, 2009 He's hypoglycemic with a questionable recall of events. He buys a board. If the fire medic doesn't want him boarded let him ride him in.
mrmeaner Posted February 23, 2009 Posted February 23, 2009 Thanks Brent. That is just something to think about. Reality is... he is elderly and has a distracting injury, story changing - aside, I would still spinal him. Where did I miss the distracting injury? Not disagreeing w/ the tx, just checking.
spenac Posted February 23, 2009 Posted February 23, 2009 If patient is altered mentally as he was based on description you can not use selective spinal immobization. If still in car KED even.
AnthonyM83 Posted February 23, 2009 Posted February 23, 2009 Around here, he would be cspined due to the possible loss of consciousness (unable to remember entire accident). In addition, there's the general unreliability in his stories, but the LOC by itself is used here to cspine (it's unclear how long ago LOC had to be in order to qualify for cspine). The airbag deployment would extra support for it, but the reason itself would be the LOC. Also, what lead the off-duty cop to suspect a heart attack? Was there distracting pain?
fiznat Posted February 23, 2009 Posted February 23, 2009 Elderly + some mechanism + possible LOC + hypoglycemic + potentially altered = He needs to be c-spined. That said, if "fire" is the ALS on scene and they are transporting with the patient, its their ass. I think it's bad medicine and you should definitely voice your opinion to them, but in the end if they are in charge it is their decision.
Just Plain Ruff Posted February 23, 2009 Posted February 23, 2009 Elderly + some mechanism + possible LOC + hypoglycemic + potentially altered = He needs to be c-spined. That said, if "fire" is the ALS on scene and they are transporting with the patient, its their ass. I think it's bad medicine and you should definitely voice your opinion to them, but in the end if they are in charge it is their decision. It's the medics ultimate responsibility and his licensure on line. You can suggest C-spine but if the medic decides no c-spine then let him lie in his own decisions. In the overall scheme of things, more than likely there is no spinal damage but until we are all supermen with x-ray vision and trained to read x-ray's better part of valor is to c-spine the guy and treat him according to your protocols.
mobey Posted February 23, 2009 Posted February 23, 2009 My bad, I mixed this post up with the one that had a broken leg.
Monhae Posted February 23, 2009 Posted February 23, 2009 I would say yes. The patient had a possible LOC (Unverifiable) and you can't rule out hypoglycemia, completely as the cause of altered LOC, because of mechanism of injury. All selective spinal immobilization protocols require a more thorough physical (palpation, ROM and neurological) assessment to make the final call though. The bigger question here is who's call is it. If the fire department says no and they are the primary care giver, then let them say no. If you are the person in charge of the transport of that patient to the hospital, and you want them boarded and collared then you also have the call. Unless that first primary care giver is transporting and accepting full responsibility for the patient, then they are transfering care to you. That makes you the liable one as well and the main liability for how that patient is turned over falls in your lap. The last time I checked spinal immobilization is a BLS skill in all 50 states. You now become the primary care giver and you can treat the patient as you deem proper. Even if it means applying the backboard or a KED and collar after they are placed on the cot. We have all made decisions, then circumstances changed before arrival at the ER and we changed or add to our treatment. Realizing that more needs to be done and doing what is necessary is the sign of a good EMT. Realizing more needs to be done but sticking to the original decisions, being inflexible, gets patients hurt or killed at some point. Know your chain of command and don't be afraid to do what I do. "Excuse me, but this is my patient and this is how I want to treat my patient. If you do not agree, then it is your patient. What can I do to assist you?" and smile and politely turn care over to them. Ive ruled out C-spine before, and half way to the hospital, the patient goes. "My neck is really starting to hurt." You shift gears and immobilize. Tha laws reguarding chain of command and continuity of care should support what I've just said in almost every state. Your patient, so do what you believe is right. You're the one who has to answer for it. If not your patient, then make suggestions, and support, if possible, the decisions of the person making them. It also never hurts to err on the side of caution.
Dustdevil Posted February 23, 2009 Posted February 23, 2009 It also never hurts to err on the side of caution. Spoken like a man who has not spent much time strapped to a backboard.
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