C Spine

[spenac]

It wouldn't cause further harm to fully immobilize the patient.

Actually there is very little scientific proof of benefit for back boards etc. But there is proof backboarding when not required does more harm than good.

[wrmedic82]

So you always backboard everyone you find at an MVA? After all, "CYA."

To answer your question, No. Based upon the situation that was described in the forum, yes I would. It all depends on the scene, the patient, and the CC. The CC of neck or back pain gets a 1 way trip to the hospital on a backboard regardless of how BS the scene is. Case and point, Ive been on scene of a relatively minor MVC, the patient I had was a 65/f CC neck pain. We packaged her up backboard, c-collar the whole nine yards. Didnt think much of it until we got to take a look at the xray. Which to say the least was a ass puckering event as the patient had a c-4 Fx. Its just a judgement call you have to make on your own. Would I transport a patient involved in a MVC with a CC of a stubbed toe who is ambulatory on scene....Probably not. However Im sure someone has a whacky story that may make me reconsider.

[joesph]

If the EMT decides not to backboard he is making the statement that the patients spine has been cleared of any injury. By what method can we do that in the field? Or the EMT is stating that the MOI was not sufficient to consider spinal injury. I personally would have to backboard considering the given info. As far as the fire/EMT not choosing to backboard does not stop you from doing what you feel and are trained is in the best interest of the patient.

[ERDoc]

For those who are not familiar, the NEXUS criteria say that you can clinically clear a cspine if all of the following are true:

1. No posterior midline cervical tenderness

2. No evidence of intoxication

3. Normal level of alertness

4. No focal neuro deficits

5. No painful distracting injuries

The CCS rules comprise of 3 main questions:

1. Is there any high-risk factor present that mandates radiography (ie, age >/=65 years, dangerous mechanism, or paresthesias in extremities)? If yes, immobilize.

2. Is there any low-risk factor present that allows safe assessment of range of motion (ie, simple rear-end motor vehicle collision, sitting position in ED, ambulatory at any time since injury, delayed onset of neck pain, or absence of midline C-spine tenderness)? If no, immobilize.

3. Is the patient able to actively rotate neck 45 degrees to the left and right? If no, immobilize.

So, given these two validated clinical decision rules, what does everyone think?

[FireMedic65]

Even at 5mph, you can sustain in injury to your neck if you come to a sudden stop. It would be unclear to me if the patient could remember what happened one moment, then not the next due to trauma or the hypoglycemia. My contacts don't come equipped with xray or ctcan capabilities. Therefor, given the circumstances, I will be treating the patient due to MOI.

From personal experience, I have seen a patient come into the ER, fully immobilized, with no complaints of pain. Patient was alert, had full recollection of the incident. The doc examined the patient and went on to do some other things. The patient was waiting on a ct-scan, and then they started to complain of numbness in their feet. Shortly after, the patient couldn't feel anything below their chest. According to the ambulance crew that brought them in, was that the patient was walking around after the incidnet, and was backboarded from the standing position. It was said the patient was driving at a low rate of speed when they swerved to miss hitting a cat and ran into a telephone pole.

So yea, I'm not taking my chances.

[ERDoc]

Even at 5mph, you can sustain in injury to your neck if you come to a sudden stop. It would be unclear to me if the patient could remember what happened one moment, then not the next due to trauma or the hypoglycemia. My contacts don't come equipped with xray or ctcan capabilities. Therefor, given the circumstances, I will be treating the patient due to MOI.

From personal experience, I have seen a patient come into the ER, fully immobilized, with no complaints of pain. Patient was alert, had full recollection of the incident. The doc examined the patient and went on to do some other things. The patient was waiting on a ct-scan, and then they started to complain of numbness in their feet. Shortly after, the patient couldn't feel anything below their chest. According to the ambulance crew that brought them in, was that the patient was walking around after the incidnet, and was backboarded from the standing position. It was said the patient was driving at a low rate of speed when they swerved to miss hitting a cat and ran into a telephone pole.

So yea, I'm not taking my chances.

And what did the CT scan show? Disability-itis perhaps?

[FireMedic65]

And what did the CT scan show? Disability-itis perhaps?

I didn't hang around long enough to see the results of the scan. When I was back later the patient had been moved to the ICU and was released a few weeks later. The ER doc said it was swelling on the cord.

[AnthonyM83]

Doing not Los Angeles.

According to NEXUS, I would immobilize based on failing to meet normal level of alertness, as presented to me through the original poster. That's where I'd need to be on-scene to make a better assessment. If his condition improves later on, I could then clear it.

[ERDoc]

I didn't hang around long enough to see the results of the scan. When I was back later the patient had been moved to the ICU and was released a few weeks later. The ER doc said it was swelling on the cord.

Eh, he was faking it.

[FireMedic65]

Eh, he was faking it.

He deserved an Oscar then if he was