Spinal Restriction

[paramedicmike]

7 hours ago, Just Plain Ruff said:

Just think of how much money the C-collar manufacturers stand to lose if we go away completely from C-collars.  

The manufacturers will survive.  We use them frequently in the ER.  People walk in after their MVC complaining of neck pain and someone in triage throws a collar on them.

I know.  I know.  Anecdote will get me nowhere.  Spock is right, though.  The worst spinal injuries I've seen have all walked, or limped, into the ER.

Like the guy who walked in after a mountain bike accident.  "My neck's a little stiff."  C4/5 fracture/subluxation. 

Or the little old lady who took a header into her basement floor while bending over to pick up laundry.  Type III Dens fracture.

For the time being, unless someone can be clinically cleared (e.g. Nexus), collars will still be used until someone can be cleared radiographically.

[Just Plain Ruff]

13 hours ago, Off Label said:

I think with the evolving understanding of crystalloid volume resuscitation and permissive hypotension in trauma, the MAST should get a second look, imo.....

just make sure that unlike some of the services that I used to work at, have a strict policy that after use, the mast dont just get folded up and put back in the bag or box, they get a thorough cleaning.  Ever opened a mast pants box after a couple of weeks in a hot outer compartment of your ambulance and the last crew who used them on a bloody trauma didn't clean them correctly????  I mean you had to use them on this critical patient but Jeesh, they really stunk.  

7 hours ago, paramedicmike said:

The manufacturers will survive.  We use them frequently in the ER.  People walk in after their MVC complaining of neck pain and someone in triage throws a collar on them.

I know.  I know.  Anecdote will get me nowhere.  Spock is right, though.  The worst spinal injuries I've seen have all walked, or limped, into the ER.

Like the guy who walked in after a mountain bike accident.  "My neck's a little stiff."  C4/5 fracture/subluxation. 

Or the little old lady who took a header into her basement floor while bending over to pick up laundry.  Type III Dens fracture.

For the time being, unless someone can be clinically cleared (e.g. Nexus), collars will still be used until someone can be cleared radiographically.

yeah, I was just being sarcastic, bad day at work leads to sarcasm on forum.  Bad ruff, bad bad.  smacks nose with rolled up printer paper.  

 

[Off Label]

2 hours ago, Just Plain Ruff said:

just make sure that unlike some of the services that I used to work at, have a strict policy that after use, the mast dont just get folded up and put back in the bag or box, they get a thorough cleaning.  Ever opened a mast pants box after a couple of weeks in a hot outer compartment of your ambulance and the last crew who used them on a bloody trauma didn't clean them correctly????

They'd have found a week old summer catfish in their boots...at the very least...gross.

[Just Plain Ruff]

3 hours ago, Off Label said:

They'd have found a week old summer catfish in their boots...at the very least...gross.

well, the last time a crew left me a nasty thing like that, I made them scrub the pants.  They may have also found something in their locker.  Maybe a week old can of tuna or something along that line.  

[Spock]

Glad to see humor has not disappeared from the City.  I did not intend to imply that c-collars would or should go away, only that they really do not restrict very much motion.  Collars will always be used as long as lawyers chase ambulances.  

Spock

[Just Plain Ruff]

18 hours ago, Spock said:

Glad to see humor has not disappeared from the City.  I did not intend to imply that c-collars would or should go away, only that they really do not restrict very much motion.  Collars will always be used as long as lawyers chase ambulances.  

Spock

lawyers don't need to chase em anymore,  they just throw on a gps tracking device and go from there. or use a drone.  

[ERDoc]

On 5/3/2017 at 4:57 PM, Spock said:

I bet ERDoc will agree with my next statement.  Ask any ED physician about the worst spinal injury they ever saw and they will probably tell you the patient walked into the hospital under their own power and not on an ambulance stretcher.   

I've seen several transected cords that, well, weren't walking anywhere, but yeah, I've seen some ugly spine injuries come in through the waiting room.

[Spock]

Agree with the transected cords and I've seen two in my career.  The first was when I worked as an athletic trainer and a defensive back ducked his head when he made a tackle.  The second was in the trauma bay at the level one trauma center where I worked for 16 years and the city medics brought in a guy that had been robbed in a downtown parking garage and even though he willing gave up every thing he had, the knuckleheads shot him in the neck.  He was conscious and alert when they moved him over onto the hospital cot.  The medics gave a report and finished up by stating almost incidentally that the patient couldn't move his arms and legs.  You could have heard a pin drop in the room.

Spock

[ERDoc]

47 minutes ago, Spock said:

The medics gave a report and finished up by stating almost incidentally that the patient couldn't move his arms and legs.  You could have heard a pin drop in the room.

WTF?

 

Back on Long Island we got a lot of motorcycle MVAs and that is where all of my transections came from.  I think in 3 years of residency I saw 5-8 of them.  I think I have seen one since.

[Just Plain Ruff]

I had a motorcycle accident where the guy flew off his bike, his spine at T12 and L1 was basically bent around the sign.  

wouldn't fit in a helicopter. 

got him to the ED, trauma center and complete severing of spine at t12/l1