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

[SSG G-man]

Sorry for not being registered already. I barely have time to read everything I get in the mail, and on the internet already, and still run calls.

My boss does not like to see me on the NEJM website during working hours. Uncle Sam wants to get his money's worth from me.

I thought I might get credit for admiting my lack of knowelge and trying to get the info, not put down because I did not already know.

[Dustdevil]

Come on, Man. You know me better than that. And I know you better than that.

I was just joking, as well as trying to motivate people at the same time.

If I wasn't trying to be helpful, I wouldn't have bothered to find that for you.

And by the way, I just now registered myself. :wink:

[SSG G-man]

Dust,

Damn, must be the lack of zzz'z lately clouding my sacasam meter. Sometimes I can not tell when you are seriously chewing a$$ or just mesing with people.

I really do want to become the best EMT I can, and do plan on moving to a "P" when I can fit it in the schedule. I thought I might get it and go as a contractor to the hot sands, but with the events of Tuesday, I might not have time before we "cut and run."

I am in a class now our county offers to allow some EMT's to start IVs. The thought process is we are in transition to haveing 24 hour paid ALS in the county, but most of the units now are a B-P team. IF a B can help start the IV access, then it frees up the P to be doing other ALS treatments. (I am sure you disagree with this!!)

Sarge

[hfdff422]

If Dust wrote it, it contains some sarcasm somewhere.

[Niftymedi911]

Down here in Fla our agency is doing the same thing when it comes to EMT's starting IV's in the field. I love it.

[hfdff422]

Sounds like Advanced EMT-B here in Indiana. You can start IV's, start fluids and do manual defibrillation. Kind of a BS cert, but it works well for medic assist situations.

[ERDoc]

I just wanted to clear up some apparent confusion about the NEXUS criteria. In order to clear someone clinically, they must meet five criteria:

1. No posterior midline cervical spine tenderness is present.

2. No evidence of intoxication is present.

3. The patient has a normal level of alertness.

4. No focal neurologic deficit is present.

5. The patient does not have a painful distracting injury

Pretty straight foward, right? Nope. I have worked with one of the authors of the original study. Here are a few notes for you. #1 is pretty straight forward. #2 pretty straight forward also. #3 this means when you examine the pt, it DOES NOT matter if they had LOC at the scene, as long as they are fully alert now, you can clear them (obviously this is where the field may be different from the hospital). #4 refers to numbness, tingling, paralysis, etc in an extremity. #5 is probably the trickiest. This is where clinical judgement comes into play. What one person feels is a distracting injury, another may not feel is. There were no specific criteria for what constituted a distracting injury in the originial study, it was at the doctor's discretion. Different people have different takes on it. Hope this helps a little. As far as being able to use NEXUS to decide not to immobilize, why not? A c-collar is inteded to keep the neck immobile until an injury can be ruled out. If you can rule out an injury with the NEXUS criteria so that you do not have to xray/CT it, what purpose is there in applying a collar?

As for the comment about the arrest at a doctor convention vs an EMS convention, that may be true at most conventions (when was the last time your pathologist did CPR?), but I must say that it does not apply to an EM convention (sorry, just had to set the record straight ).

[BushyFromOz]

#3 this means when you examine the pt, it DOES NOT matter if they had LOC at the scene, as long as they are fully alert now, you can clear them (obviously this is where the field may be different from the hospital).

How does this work if they are in the lucid period between the first loss of conciousness and a raising ICP, which can take hours do develope? The MOI would generally [insert varying factors here] would indicate immobilisation, but the NEXUS may clear them?

Also - if EMS'ers immobilise due to LOC at scene, how does hospital justify dismissing this exact same piece of information?

This is interesting

[ERDoc]

How does this work if they are in the lucid period between the first loss of conciousness and a raising ICP, which can take hours do develope? The MOI would generally [insert varying factors here] would indicate immobilisation, but the NEXUS may clear them?

Also - if EMS'ers immobilise due to LOC at scene, how does hospital justify dismissing this exact same piece of information?

This is interesting

Head injury does not equal c-spine injury. If they are conscious when you see them and you are able to clear them, how are they going to sustain a cspine injury before they lose consciousness again? At the hospital we will not dismiss the LOC at the scene, they will usually end up getting a head CT (even this is currently being debated in the literature, but I am not that brave). Honestly, if you end up bringing in a pt that was conscious and then became unconscious, their neck is going to get imaged anyway. One thing that the NEXUS criteria did not address is age. I will not usually use NEXUS in elderly pts.

[BushyFromOz]

Head injury does not equal c-spine injury

I was thinking in terms of MOI and correlations between between the two. Any MOI enough to cause a loss of conciousness is enough to cause a c-spine injury.

I asked this because i had a patient who had a loss of conciousness, regained it for about 30 minutes when he collapsed from a sub arrachnoid and was later found to have a c-spine. As i disclaimer, i was not summoned until he collapsed the second time 8)

their neck is going to get imaged anyway.

I guess the answer i was after is in here :wink: