TRAUMA - Episode 15, April 5, 2010

[maverick56]

It is outside the scope of practice for Paramedics in the state of California.

This is why RNs are usually found staffing flight teams in that state and not Paramedics.

Ok, thanks.

Yes. How do you splint a neck in the position found? There is a brand new collar out on the market now that supposedly does it, but I don't know of anyone using it.

I would have said screw the c-collar and improvised, used a blanket or sandbags, a frickin sweatshirt if it could be fit around the head, secured to the pt and the board, and helped stabilize things. But then I'm used to improvising and don't know how many civilian protocols would flip on that, haha.

[ccmedoc]

Ok, thanks.

I would have said screw the c-collar and improvised, used a blanket or sandbags, a frickin sweatshirt if it could be fit around the head, secured to the pt and the board, and helped stabilize things. But then I'm used to improvising and don't know how many civilian protocols would flip on that, haha.

I think splinting in position found is ludicrous. Positioning to inline with gentle traction applied during rotation should be allowed. I stress 'Gentle', and cease rotation if 'any' resistance is met...I think airway management would be very difficult with the positioning of this patient as laying, even with the Crich crowd.

I think this treatment was OK..The RSI was questionable, nasal intubation after the fall from height and obvious impact of the head. Basal skull FX a thought???

I would hate to intubate the cranial vault....This was a bad decision.

-IMHO....

Edited April 7, 2010 by ccmedoc

[Quakefire]

My protocols and training agree with CCMedoc, attempt to rotate inline with gentle traction, stop if you feel any resistance. If she was that uncx, then why was an RSI required? They should have at least checked the gag reflex before loading her up on drugs. And yeah anything nasal is bad news..... now thats direct oxygenation.

[Richard B the EMT]

All I can tell here is a bunch of us don't like California protocols. I'll start a separate string to ask why.

[maverick56]

I think splinting in position found is ludicrous. Positioning to inline with gentle traction applied during rotation should be allowed. I stress 'Gentle', and cease rotation if 'any' resistance is met...I think airway management would be very difficult with the positioning of this patient as laying, even with the Crich crowd.

I think this treatment was OK..The RSI was questionable, nasal intubation after the fall from height and obvious impact of the head. Basal skull FX a thought???

I would hate to intubate the cranial vault....This was a bad decision.

-IMHO....

I didn't say that it shouldn't be allowed, only that it would not be my first instinct to realign. Ultimately, it's difficult to say what I would do without being there, seeing/feeling it. I agree that airway would be difficult, but I personally have more confidence in my surgical airway skills than moving bone bits around the spinal cord. Understand, I'm not disagreeing here, just trying to think it thru in the "if this were me" sense. It's a very interesting and realistic sncenario that could happen anywhere in the country. I'm a combat medic by trade - I hear load-and-go and think serious expediency and strength of skill-set.

What makes the RSI questionable? I'm a second-quarter medic student, I really have no idea. I totally agree with you on the nasal intubation, I would have been definitely concerned with skull fx after a fall like that.

All I can tell here is a bunch of us don't like California protocols. I'll start a separate string to ask why.

I could care less about CA protocols, I'm just a student asking questions.

[Chief1C]

If we left people as we found them, someone would have to start making SAM Splints the size of backboards. Leave it as you found it, has a place in EMS, but I disagree with leaving every patient with their head in an odd position. Why not go back to the old days, and just man handle the trauma victim onto the cot, with a pillow under their head.

[ccmedoc]

What makes the RSI questionable? I'm a second-quarter medic student, I really have no idea. I totally agree with you on the nasal intubation, I would have been definitely concerned with skull fx after a fall like that.

Not that it wouldn't be indicated, but what she did wasn't appropriate here..RSI with inline stabilization and ORAL intubation..See the cords and pass the tube..that's all. I guess I was saying "HER" RSI was questionable.

I am not a big fan of nasal intubations in general, and performing one here is way off base in this scenario.

I understand some would not think to align the neck initially, but to splint in the the lateral facing position would be most difficult to secure, and I think you would get dinged on arrival to the ED for sure..Airway is priority...and sandbags are a no-no..

I wasn't necessarily bashing your position on the re-alignment, just making note that is should be standard procedure..

[maverick56]

Not that it wouldn't be indicated, but what she did wasn't appropriate here..RSI with inline stabilization and ORAL intubation..See the cords and pass the tube..that's all. I guess I was saying "HER" RSI was questionable.

I am not a big fan of nasal intubations in general, and performing one here is way off base in this scenario.

I understand some would not think to align the neck initially, but to splint in the the lateral facing position would be most difficult to secure, and I think you would get dinged on arrival to the ED for sure..Airway is priority...and sandbags are a no-no..

I wasn't necessarily bashing your position on the re-alignment, just making note that is should be standard procedure..

Thanks for the answer! I appreciate the insight - as I said, I'm still in school and my background in combat-skewed. And I don't worry about bashing, I have a thick skin and am here to be a sponge.