I nead your opinions on a MVA call that I went on.Thankx

[Dustdevil]

An neuropathy 95% of this job is judgement calls.

Or do you just board everyone.

Put everyone on oxygen

Start an IV on everyone

Place them on a monitor

Put traction on every femur fx.

In that case you have all your bases covered and you have nothing to worry about.

Most on the other hand treat people based on assessment.

My feeling is people who over treat, are lacking good assessment skills. They over treat to compensate for their insecurities as a provider.

Judgement calls are also known as a decisions. And yes I make them everyday.

Minus five for an incredibly ignorant post.

Judgements are properly made based upon scientifically validated criteria. We don't just fly by the seats of our pants, and take wild guesses, pulling our judgements out of our arses. We evaluate the scenario and facts we are presented with, and then we compare those with the known standards we should have learned through quality education, and only then do we make our so-called "judgement calls." Apparently, Ghurty and Neuropathy either received a better education than you, or else they are just smarter than you because they understand that the assessment of this patient adds up to a mandatory c-spine precaution extrication based upon *at least* the following:

• 1. The patient is not fully oriented.

2. The patient has other painful, distracting injuries.

• That's it. The patient just bought herself a KED. And she is going to lose the car door (and probably the steering wheel) too. Any other "judgement call" you make will not be supported by the literature, the research, PHTLS, ITLS, the Maine Protocol, the Ottawa Rules, or any other reputable and widely recognised standard of care.

It is good to know that you are so focused upon "assessment skills," because you obviously have a lot to learn about them.

[Malignant-Hyperthermia]

Before i start, i will say that i am Neuropathy i was playing with my profile and locked myself out accidently.

Ahh wit wit wit.........

i have 2 points for you my ignorant friend

[Dustdevil]

2. NEXUS - go read about it

Yeah, that's the word I was looking for. :thumbright:

[whit72]

Ah there is shock, someone siding with Dust.

First of all the definition of decision is:

act or process of deciding; determination, as of a question or doubt, by making a judgment

So in fact every decision made is a judgement call.

I did not state anywhere to not immobize her.

If she is immobilized I dont care, really how she gets out of the car. Roof flap, door punch, or out the passenger side. That is what I stated was a judgement call, how she was removed (decision).

I simply stating a thorough assesment needed to be conducted as to determine the priority of this pt.

It either wasnt done or wasnt stated.

As far as for the NEXUS study.

posterior midline cervical spine tenderness = none or wasnt stated

focal neurological deficit = none or wasnt stated

altered level of alertness = none or wasnt stated (the fact she cant recall impact dosent means she altered, most dont remember impact including my self who has been involved in a few MVA's) I actually believe it was stated she was alert and oriented.

Under the influence = none or wasnt stated

Distracting painful injury = Maybe but a lac to the head is a stretch.

So in closing I again state to you as a rookie choose your battles carefully, As long as she is immobilized. Does it matter which way she is taken out of the car. drivers side, passenger side, roof flap.

To me the main concern that she is immobilzed correctly in the car before extrication. Diagree all you want.

That is my main focus.

[Dustdevil]

I did not state anywhere to not immobize her.

If she is immobilized I dont care, really how she gets out of the car. Roof flap, door punch, or out the passenger side. That is what I stated was a judgement call, how she was removed (decision).

Ah, well then in that case I still don't fully agree with you, but I do at least disagree with you less.

I simply stating a thorough assesment needed to be conducted as to determine the priority of this pt.

It either wasnt done or wasnt stated.

This is what was stated in the original post:

• There ya go. Two points, with no stretch necessary.

So in closing I again state to you as a rookie choose your battles carefully, As long as she is immobilized. Does it matter which way she is taken out of the car. drivers side, passenger side, roof flap.

That's a bit like asking of it really matters whether we take the dirt road or the paved highway. Of course it matters. I am concerned that you don't seem to realise that.

[Malignant-Hyperthermia]

Im having difficulty understanding what exactly you are trying to prove.....

on one hand you are making statements consistant with full c-spine precautions

on another you are making a case to deny the pt may infact have a potential injury

As Dust said..

1. The patient is not fully oriented.

2. The patient has other painful, distracting injuries

I point you to this article..................http://www.fieldmedics.com/articles/the_nexus_study.htm

if this is not reliable enough, i can find many more published artiscle for you, though finding a free one is the challenge

I will point out however....

Altered level of consciousness is defined as any deviation from being fully awake and alert. Emotions such as anxiety and apprehension must also be taken into consideration when examining the patient. A report of a loss of consciousness, no matter how brief, should be considered an alteration even if the patient is now fully awake and alert. In the elderly or mentally challenged patient the presence of dementia or impaired thought process limits your ability to perform an accurate exam, which would lead to selective spinal immobilization in these cases.

sound familiar? what about..

A painful distracting injury is any injury that causes the patient so much pain that he might not recognize his neck hurts or that he has numbness or weakness. The most common distracting injuries are obvious fractures and severe soft tissue injuries such as large lacerations, crush injuries, burns, and contusions. If you are unable to keep the patient from concentrating on these injuries, you will be unable to proceed to use the criteria, and should immobilize the patient.

You mean like the kind of laceration you get from amcking your head against a windscreen to the point it leave i nice snowflake in the glass?

[windsong]

My thoughts on this is he needs to be reported/written up, so that in the near future it doesnt happen again.

What is the common denominater for an Idiot? 56, the lower you go the more stupider they get.

[whit72]

Ok this is the last time I will state I never said don't immobilize her.

He asked our opinion on how to broach the subject, I answered.

Furthermore:

There was no mention of any LOC in the statement. I am guessing no one asked.

There was no mention of any spinal neck/back point tenderness. I am guessing it wasn't assessed

There was no mention of any neuro deficits. I am guessing it wasn't assessed.

No, I feel confident in the fact that if I choose to immobilize someone in a car, I am quite confident, that it wont matter how the pt is extricated.

I am not an extrication specialist, my job is to prepare the person safely and securely for any means of extrication.

I love the fact that people have a problem with the fact that its not of big importance to me how the pt is extricated.

Everyone now quotes nexus, but has no problem that the actual NEXUS assessments were not followed.

Typical EMT city stuff. And the reason why although I do enjoy this sight at times, it dosent really hold much credibility.

[Dustdevil]

Ok this is the last time I will state I never said don't immobilize her..

I understand that. But then again, what you actually mean isn't entirely clear. You go off on a tangent about "overtreatment," and then state that the patient did not meet your criteria for spinal immobilisation. Although you didn't outright say not to board the patient, you certainly implied that you would not have yourself.

There was no mention of any neuro deficits. .

How do you figure that? Not being oriented to the precipitating event is a neuro deficit.

No, I feel confident in the fact that if I choose to immobilize someone in a car, I am quite confident, that it wont matter how the pt is extricated.

I love the fact that people have a problem with the fact that its not of big importance to me how the pt is extricated.

Again, I am appalled that you don't think it is important when all reputable medical standards say it is. All extrications are not equal. If the patient has to stand up to sit on the board, or if her body must be over-manipulated to be extracted, that is important! It matters! How can you possibly think that it does not?

I am not an extrication specialist, my job is to prepare the person safely and securely for any means of extrication.

Now you are contradicting yourself. Let me quote you something a wise [but sub-literate] man said earlier in this discussion:

• Remember saying that? Why would you say that earlier, and now abdicate your responsibility to be an advocate for your patient's care and safety? You do not have to be an "extrication specialist" to recognise the superiority of one technique over another. YOU are in charge of that patient's care and safety, not the "extrication specialists." YOU need to be that advocate you spoke of earlier and assure that others are not taking the lazy way out just for expediency.

It sounds to me like all this adds up to you copping an attitude that, "this patient probably doesn't have a spinal injury, so I don't really care if her immobilisation is efficacious or her extrication is optimal," or worse yet, "It's not my job." Either of those attitudes are firing offences in my book.

Everyone now quotes nexus, but has no problem that the actual NEXUS assessments were not followed.

Again, how do you figure that? They recognised the MOI, the altered level of orientation, and the distracting injury and chose to immobilise. The patient clearly met the criteria, and it only takes one positive to do so. If you want to talk about things that don't matter, knowing the name of the NEXUS, or Maine, or Ottawa spinal protocols would be very high on that list. I don't care what my partner calls the protocol, so long as he knows how to apply it. Anthony did.

And speaking of Anthony, let us return to his question. I agree with you. Yes, he should have been a patient advocate for proper care of this victim. He was thinking correctly and his partner was being lazy. He should have called the guy on it. But I also remember what it was like to be a n00b, constantly questioning and second guessing yourself because you do not yet have the experience to validate your knowledge. I remember many times watching my senior partner doing something I thought was incorrect, yet thinking silently to myself, "Well, he has more experience than me, so he must know something I don't know, so I'll keep my mouth shut." It's damn hard to tell somebody with more experience than yourself that they are doing something wrong when you are fresh out of school. Not only do you run the risk of looking like an idiot when they show you why you're wrong, but in any case, you risk alienating your partner who now thinks you are either an idiot or a smart arse. So yeah, I totally understand the concept of just staying silent and going with the flow in many such cases. But remember, you run almost as much risk by remaining silent, because if the scene goes bad, the powers that be will be looking at BOTH of you wondering why neither one of you knew wtf you were doing. Then your claim that you knew better but didn't want to rock the boat isn't going to save your job.

I'm just glad I am not a rookie anymore!

[becksdad]

My feeling is this: If you're going to c-spine, do c-spine. Don't half-ass it. A collar does not immobilize c-spine. All precautions still must be taken to avoid manipulating the spinal column. For seated patients in MVC's, and especially for seated patients where extrication presents a challenge, that means not only a collar, but a KED. So many people think a KED is a pain. Yes, it takes longer. But it is the only means we have to eliminate as much as possible moving the spine where suspicion of injury exists.

And we cannot dismiss suspicion of spinal injury just because the last 99 people in similar incidents were injury free. Mechanism + c/o head/neck/or back pain buys you immobilization. No question. This is one of those instances where I fully believe in textbook application. Fit the right collar. Be sure head is neutral, in-line. Strap snugly to head blocks placed appropriately. Strap collar to board snugly. Use KED if indicated. Use 4 board straps. A lot of people get put on a board sloppily, and there's just no excuse for it. Lunch will still be there, and if you're lucky, "Turd Watch" will be over.

The patient described here was without question in need of immobilization. Anthony, your thoughts were right, and I sympathize with the position of being new and the lone dissenting voice. But give yourself permission to take charge of a scene. I don't mean to go in and be a jerk, I mean you can get to the patient first, and begin diplomatically asking others to help. If you arrive to find c-spine being held, ask FD to give you a collar and KED in this case. A good partner will not disuade you from appropriate treatment. A good partner will stop you if you are going to do something that will harm a patient, and assist you in providing the best care. Likewise, if you see something about to happen that bothers you, you can always stop the action for a minute and ask a question or make a suggestion. Sometimes, someone may surprise you by saying "good idea". Sometimes not. You seem like an intelligent guy, I think as time goes on and you run into more and more different situations, you will get a feel for interacting with partners and other responders while remaining an effective patient advocate. Good luck, man!!