PT c/o SOB while immobilized

[skinut2234]

This almost came up the other night-

What if you come upon and MVA- neck pain..... etc etc (standard BLS call)

You board, collar- C-Spine pt... get them into rig.

While en route- your pt. complains of diff breathing and needs to sit up..... your pt. is strapped to the board and states they really need to sit up to breathe..... Since "B" is very important (obviously)- What do you do??

[medic001918]

It would depend on the cause of their difficulty in breathing to totally answer your question. One thing that I have done is to sit them upright immobilized with a KED. Keep in mind that this is an incomplete application of immobilization, but as a paramedic here we're allowed some room for independant thought. It's far less than ideal, but better than a patient who can't breathe effectively.

Shane

NREMT-P

[Ridryder 911]

You raise the "whole" board by placing blankets underneath the board raising the board slightly.Although, they you cannot technically "raise" the head up, remember to continue with administration of oxygen, and reassessment of why the patient is having s.o.b. ?

good luck in your studies.

R/R 911

[akflightmedic]

Until you provide a more detailed description of the patient, I will make these assumptions based on what you have said thus far.

First, Is the patient suffering from orthopnea? If you don't know what that is, please look it up and get back to me and tell me what kind of physical presentation a person suffering from this typically has.

Secondly, the pt stated that they "really needed to sit up". Just the way you quoted them makes me think...Did they really? Or is this just a case of the provider failing to recognize that a pt is uneasy, anxious or possibly claustrophobic. This is where experience kicks in. First, you do another assessment of lung sounds and SPO2 if available and check other signs of adequate perfusion. Then you apply O2 via nc and you get close to your pt and you talk in a calm and soothing voice and reassure them until they are able to calm down and the need to sit up subsides. You can also raise the board with towels or equipment, but mostly from your short post it sounds as if it was anxiety and therefore you should provide TLC.

[AZCEP]

I agree with Rid and ak.

If the patient is abnormally large (read: obese), lying flat will make it next to impossible to get good chest expansion. Raise the head of the board 10-15 degrees so the weight is moved a bit, and things should improve. Anxiety states need a calm voice to reassure them that they will be okay.

Re-assess lung sounds and vital signs. Somewhere I remember reading that chest trauma can cause shortness of breath, right? Worse comes to worse, coach their respiratory rate, and maybe assist with a BVM. Doesn't happen often, but it can be useful, if the patient will let you use it.

[xselerate]

All of these are good suggestions but I just thought of something fairly obvious.... your concern (and mine) on a basic level is the viability of your patient. They are immobilized because further injury to a spinal cord fx could really harm the viability idea, so we have c spine out of the way. Now.... your patient is complaining about SOB.... your patient is complaining.... meaning they can speak.... meaning that even if they don't know they are okay (and viable) you should know they are. And worse comes to worse you always have you trusty ambu bag. Immobilization is critical if the MOI demands it (I can't speak for any practices medics may have with KEDs) and there is no reason why you can not go into an ER with an fully immobilized and breathing patient (be it that they are breathing or you are breathing for them.)

[Para-Medic]

I agree with Rid and ak.

If the patient is abnormally large (read: obese), lying flat will make it next to impossible to get good chest expansion. Raise the head of the board 10-15 degrees so the weight is moved a bit, and things should improve. Anxiety states need a calm voice to reassure them that they will be okay.

Re-assess lung sounds and vital signs. Somewhere I remember reading that chest trauma can cause shortness of breath, right? Worse comes to worse, coach their respiratory rate, and maybe assist with a BVM. Doesn't happen often, but it can be useful, if the patient will let you use it.

Just to be sure, only assist with BVM if signs of poor perfusion are present, right?

[AZCEP]

More along the lines of poor ventilation.

[Ridryder 911]

Oh .. Oh.. are we tryin gto say there is a difference in V/q... ? LOL

R/R 911

[PRPGfirerescuetech]

This almost came up the other night-

What if you come upon and MVA- neck pain..... etc etc (standard BLS call)

You board, collar- C-Spine pt... get them into rig.

While en route- your pt. complains of diff breathing and needs to sit up..... your pt. is strapped to the board and states they really need to sit up to breathe..... Since "B" is very important (obviously)- What do you do??

Judging by how you wrote this, it sounds like more of an anxiety and claustrophobia issue, less medical. The answers are in the prior posts, but also, I pose a question.

If said patient is an anxiety and claustrophobia, and we allow them to refuse, does the liability remain on the provider due to the frantic state of mind the patient was in when they refused the tx?

(im tired, and will clarify if asked)

*Spellchecked, no mistakes....ha ha, i didnt have to not give a s*%t that time