Spinal precautions

[JPINFV]

I intended for my post to indicate that it requires far less force to cause a c-spine fracture than many people believe. I don't know how anybody can feel comfortable ruling out c-spine on an unconscious head trauma pt.

The underlined is my issue. Saying that axial load injuries take little force to create a c-spine fracture, hence c-spine injuries are easy to cause is like saying that cars provide little protection because the roof isn't reinforced like the front, back, or sides. Sure, it's true, but how many car accidents out there involve the roof being caved in? Relatively few because the roof won't be involved unless it's a roll over. Similarly, I'd argue that very few traumas result in any significant axial load like a hanging does.

Additionally, I don't know anyone who would consider an unconscious trauma patient to be asymptomatic.

[Canadian Caesar]

Sorry guys but I just laugh my ass off watching things like Trauma: Life in the ER and see a guy come in all boarded up with blocks and tape and whatnot because he fell over on the sidewalk and knocked himself out.

Did I miss read the intentions behind this statement then?

Unconcious Pt Knocked out from fall + C-spine precautions = somehow ridiculous?

[Canadian Caesar]

The underlined is my issue. Saying that axial load injuries take little force to create a c-spine fracture, hence c-spine injuries are easy to cause is like saying that cars provide little protection because the roof isn't reinforced like the front, back, or sides. Sure, it's true, but how many car accidents out there involve the roof being caved in? Relatively few because the roof won't be involved unless it's a roll over. Similarly, I'd argue that very few traumas result in any significant axial load like a hanging does.

Additionally, I don't know anyone who would consider an unconscious trauma patient to be asymptomatic.

I don't know where this fixation on an asymptomatic spinal pt came from, since:

1) neither have I mentioned at any time an asymptomatic pt and

2) neither is the pt mentioned by kiwi and quoted by me in my original post asymptomatic by any stretch of the imagination.

Where is the confusion coming from?

Do cars not roll over where you come from? Easily 20-30% of serious MVA's I do are roll-overs. Perhaps due to the prevalence of pick-ups and other high center of mass vehicles around these parts? Your analogy is a fail, at least where I come from.

I'm having trouble finding actual quantities of force required to cause c-spine fracture. So I posted the first quantity I came across. Admittedly, a hangman's fracture would not be the most common in trauma. But I was doing the best with he numbers I could find. And I'm still looking.

So if you would like to find relevant literature to support your argument, instead of making bizarre and irrelevant automotive comparisons, I would welcome your efforts.

Edited October 18, 2009 by Canadian Caesar

[Canadian Caesar]

BTW, That kind of reads as more hostile than how is was written.

Just to be clear, no disrespect meant. Just interested in getting to the bottom of the matter.

[kohlerrf]

I don't believe I have ever read or learned anywhere that a C Collar immobilizes the c-spin. In fact I have experience to the contrary. In trauma the C collar is probably the last thing I worry about the first is to dedicate one individual to hold manual stabilization and maintain and open airway a c collar can get in the way of a jaw thrust or selleck maneuver or a at worst case a cric. manual stabilization also can pull traction and prevent vertebra from rubbing together and allows us to maintain the proper orientation of the head to the torso during movement of the body until we eventually get the pt on the board. if there is a minimal or no possibility of airway compromise applying the collar can aid in stabilization but does not replace manual stabilization. In short C-Collars are an aid only, when you put them on is up to the circumstance and dont get caught not holding manual stabilization until your patient is secured head to toe on the back board.

[AnthonyM83]

But can you show me where there is any evidence that the collar is valuable?

I don't have the source data, but I have read stats about how much movement a properly placed c-collar prevents (flexion and also rotational). The statistic was mentioned in the context of reminding the student that the collar doesn't prevent most a large amount of movement, so manual stabilization is THE most important. Yet, it does work to a good degree (especially flexion). Too late to go to my car and find it right now.

As far as people fighting the collar, THAT'S when you can decide not to use it. Done it a number of times. BUT the majority of my patients are stable, not altered, haven't been drinking, and won't actively fight it. Also, students are told the collar is to help REMIND the patient not to move his head, rather than actually preventing movement. I tell my patients the same thing when applying collars to them.