3 ft fall spinal immobolization

[ERDoc]

I would have used spinal precautions with this patient and here is why. While the patient only fell 3 feet, there was trauma noted to one arm and also to his head. Since we can not see inside of his head & cervical spine then it is best to take precautions. I had a fellow Paramedic who cleared a guy who had a small branch hit him on the head while trimming trees in his yard. The guy looked fine except for a small laceration on top of his head. The Paramedic opted not to take spinal precautions, but when they arrived at the ED a CT was ordered and it revealed a sublaxation of his cervical vertebrae.

What does the trauma to the head have to do with the cervical spine? What criteria did the medic use to clear the c-spine in the case?

[1EMT-P]

There have been studies done in the past that show a connection between head trauma and cervical and spinal injuries. Closed head injuries can be caused by accidents, falls and related trauma.

[ERDoc]

So you don't believe in clinical decision tools? Again, what criteria did your paramedic friend use to clear his pt?

PS-You can't just say that studies have been done, you have to provide those studies.

[croaker260]

I think what ERDoc is trying to say is HOW did the "Paramedic" "clear" ( a misuse fo the term) the c-spine. What assessments did he perform.

What he is wondering is if he did it "correctly".

Saying Selective Spinal Immobilization (AKA "Clearing the C-Spine" ) protocols dont work, if they were misused in the first place, is not an accurate, or helpful, statement.

Edited February 3, 2014 by croaker260

[ERDoc]

Let's give this "paramedic" the benefit of the doubt and say he properly applied the NEXUS criteria (although the fact that the pt got a CT in the ER makes me doubt this), don't forget, the NEXUS criteria are only 99.6% sensitive, meaning you are going to miss that 0.4% of clinically significant spine injuries. The Canadian cspine rule has a sensitivity of 100%, so if applied properly you shouldn't miss any. Like I said in an earlier post, for the original pt, as presented NEXUS says no and CCSR says yes.

[Leprechaun]

The patient hit the ground with enough force to fracture his arm therefore that same level of force was applied to the rest if his body. Secondly, because he has a fractured arm a spinal rule out can not be performed because his fractured arm is now considered a distracting injury. He must be immobilised. Sent from my iPhone using Tapatalk

Edited February 5, 2014 by Leprechaun

[ERDoc]

The patient hit the ground with enough force to fracture his arm therefore that same level of force was applied to the rest if his body. Secondly, because he has a fractured arm a spinal rule out can not be performed because his fractured arm is now considered a distracting injury. He must be immobilised. Sent from my iPhone using Tapatalk

That's the problem with NEXUS, a distracting injury isn't defined very well and is very subjective. How many people fall and break their arm and have no spinal injuries? I would say it would be most.

[island emt]

A distracting injury could be a fingernail torn off [extremely painful] ,or a compound fracture,

All depends on how the PT feels and deals with pain.

[Just Plain Ruff]

You know I fell on the ice this morning, I hurt my Butt pretty bad, had the ambulance called for me this am because I could barely get up and some foreign idiot called EMS, They wanted to fully immobilized me because they said I had a distracting injury of butt pain and they couldn't rule out a spinal injury.

[scubanurse]

Haha... something similar happened to me last year, I fell going UP stairs and busted my knee wide open. Someone called EMS since my leg was gushing blood, they heard that I fell DOWN the stairs and started trying to put a c-collar on me. Sille EMS providers making assumptions and jumping to conclusions.