Question about C-spine??

[tomcbad]

I would like to know if any one would cspine a person involved in a mvc with no neck pain. Pt only complaint right scapula pain. ETOH involved restrained driver air bag deployment. There was moderate passenger side damage and the driver compartment was intact. CAO times 4 no past medical hx 20 yo f. Pt neck and back non tender on palp -deformities noted. Any input would be appreciated.

[Just Plain Ruff]

UHHH I think your protocols would say YES!!!! but I don't see them so I'd say yes

Scapula pain - I would collar her and lsb him. ETOH yep she'd get a c-collar

Moderate damage on the car - YEP

Airbag deployment - you didn't say anything about seat belts. If airbag deployed and she wasn't wearing a seatbelt which I cannot believe that someone with ETOH wouldn't use a seatbelt, then heck yes I'd collar them.

We all know that Drunks are too STUPID on scene to know what's best for them.

What did she hit?

[Eydawn]

Few more questions...

How drunk was she? Remember that ETOH can mask symptoms; she might have neck pain that she's too goofy to be aware of at the moment. Everyone responds differently to alcohol. Was she compliant with you, were you able to explain things to her? Was she ETOH+ to the point that she would have been unable to refuse treatment?

Were there deformities present? Kind of unclear from the way you wrote it, I couldn't tell if she was negative both on pain and deformity, or just on pain.

Any LOC? She might be AAOx4 now, but if she had a loss of consciousness before you arrived on scene, that's another good indicator that she needs to be collared.

Given the location of the scapula, I'd say it's safe to assume that she might have a spinal injury as well. Remember that pain from other injuries can also mask pain, especially in something close by.

Any other injuries noted? Any other individuals in the vehicle, and if so, what were their injuries? (More clues to the severity of the impact).

Remember, also, when in doubt, C-spine it. If you're not sure, then assume yes. Worst that can happen to her, she gets a little stiff from hanging out on a backboard for a while, whereas if you don't collar her and she has a spinal injury, she can end up paralyzed or dead. You're not an X-ray machine (although that would be cool! Who doesn't want super powers!) and you have some qualifiers I would have C-spined her for.

So what did you end up doing?

Eydawn

NREMT-B

[xselerate]

Few more questions...

All excellent... I admit I wouldn't have thought of all that... getting paid what we get paid I wouldn't have put so much thought into it if I knew I was just goin to immobilize them anyway... which I most certainly would have

But still... all really great points made by Eydawn...

[ERDoc]

From the hospital standpoint, the only confounding variable here is the EtOH. If she presented the same wihtout the EtOH, the collar would come off and she would go home (assuming no other injuries obviously). EtOH gets a collar and xrays, and likely a CT (depending on the xrays).

[medic001918]

From the hospital standpoint, the only confounding variable here is the EtOH. If she presented the same wihtout the EtOH, the collar would come off and she would go home (assuming no other injuries obviously). EtOH gets a collar and xrays, and likely a CT (depending on the xrays).

+1 as usual to ERDoc. Anytime a patient has something in their system that may alter their levels of pain makes them "unreliable" for us to follow the protocol for withholding spinal immobilization. Otherwise, without being there and seeing the car it's difficult to say just how bad the damage was. Many factors come into play such as restraint (as previously mentioned), speed, the other object? From the description you gave, I would immobilize them. Given the same scenario w/o the ETOH on board, and I might not. Remember though that where I work we have a protocol to withhold immobilization. If you do not, then the patient should defiantly be immobilized.

Shane

NREMT-P

[Dustdevil]

Trauma naked!

[EMT_Kyle]

I think a cspine is a appropriate measure. Any traumatic force such as a mva i'd put a cspine on as a precaution at the least.

[canuckEMT]

Sounds like there was significant mechanism there: Airbag deployment, passenger compartment intrusion ( 1)

ETOH + = unreliable pt (2)

Therefore 2 positive aspects according to ITLS and in my area the CCR for full spinal motion restriction.

Just remember to keep the suction handy and if she spews, roll her towards your partner cause the cupboards in the unit are tougher to clean!!!