katbemeEMT-B Posted June 15, 2007 Posted June 15, 2007 Hey Now i am a nurse too....but we do get attitudal sometimes and CB you mean you dont practice CYA medicine :?: :?: :?: Well Terr, I guess some people are just better at their job than we are. :laughing9:
BushyFromOz Posted June 16, 2007 Posted June 16, 2007 In that case it would have come down to whether or not you deemed the elbow to be a distracting injury. That all depends on the patient as everyone handles pain differently. I suspect it would be considered distracting in a 9 y/o. I certainly wouldn't fault someone for bringing her in on a board. My thoughts right there, id like to know just how this pt was handling her injury. "Swollen and painful" can describe a whole lot of injuries, and not all of them are significant, and not all falls are significant either.
Dustdevil Posted June 16, 2007 Posted June 16, 2007 My thoughts right there, id like to know just how this pt was handling her injury. "Swollen and painful" can describe a whole lot of injuries, and not all of them are significant, and not all falls are significant either. Agreed. Unless the girl was all but ignoring the elbow injury, I would have to count it under the "distracting injury" criteria. The good news is that the elbow impact probably lessened or eliminated any forces that might have injured the neck. However, that is certainly not a given. And we must remember that it is not so much the force involved that causes SCI, as it is the angle at which it is applied. We've all seen people take one hell of a blow to the head without spinal injury. And, of course, I have seen plenty of SCIs without pain or neuro deficit on the scene, including my own. In all probability -- based upon the info provided here -- I would have immobilised her. But, depending on how well you articulated yourself in your SOAP, I would consider medic discretion to be appropriate in the matter. That better be a thoroughly impressive SOAP though.
CBEMT Posted June 22, 2007 Posted June 22, 2007 Hey Now i am a nurse too....but we do get attitudal sometimes and CB you mean you dont practice CYA medicine I practice medicine for patient. I document for the lawyer.
whit72 Posted June 22, 2007 Posted June 22, 2007 Lady firfighter wrote: Nurse at the hospital questioned us for quite some time about WHY, and did it in front of the patient's parent. Parent commented that they were glad we took the extra precautions, than not. Nurse was irate that we had her on a backboard for a very minor isolated injury. The nurse is a knuclehead. Dont sweat it. Shes probably been a knuclehead long before you came along. She gets a board on mechanism alone. If she dosent need it oh well you just got a little more practise immobilizing someone. No biggie. What if her elbow was not the first to hit the ground? What if she landed on her head going 30mph, still enough energy to smash the elbow as a secondary injury. We just had a two year old fall off a bed maybe 10 inches off the ground. When the crew arrived language barrier, kid acting appropriatley, no neck back point tenderness. No defecit noted No distracting injury. Sitting their playing with a doll. They decide to immobilize on the language barrier alone. Come to find out the kids got a c2, c3 circumflexion (not sure if i am spelling that correctly), and a bleed. Fifteen minutes later she is in a helicopteron on the way to a childrens hospital. Thats probably one in a million. Now that kid wont be sitting in a chair for ever, having someone feed her breakfast. I allways err on the side of caution. HOw often does a kid fall off their bed and it just gets blown off by the parents. Scary.
ladyfirefighter36 Posted June 22, 2007 Author Posted June 22, 2007 Sorry that we have to live in a CYA society. But we do, and I don't mind taking a few extra precautions for my patient. I would rather err on the side of caution, than not, with any kind of treatments or interventions. We see too many patients, after the fact, with injuries not expected. After doing all of our assessments, we are not CT scans, we cannot find everything.
ERDoc Posted June 22, 2007 Posted June 22, 2007 Whit, I'm not sure what you mean by a circumflexion so I cannot comment on that. It is very rare for kids, especially this young, to end up with cervical injuries. Their bones are mostly cartillagenous at this point and can take quite a hit without any problems. Accicents that result in any form of injury are usually fatal. This is true in healthy kids. If a kid has some sort of underlying bone problem (ie osteogenesis imperfecta) then this does not hold true. Obviously I cannot comment on this kid, but I also said extremely rare (not impossible). Using the NEXUS rules, it does not sound like you can clear this kid (language barrier, can a 2 year old really tell you about midline tenderness?). Not sure where this kid falls on the CCS rules as I am not as familiar with them. Also keep in mind that not all cspine fxs are unstable (not that you can tell that in the field). I learned that this past week. We had a 24y/o who was running in some shallow water and though it would be a good idea to dive head first into the water. Imagine his surprise when a bunch of rocks jumped in his way and he hit them with the top of his head. This was at 0230 (yes, alcohol was involved). He came in about 14 hours later because the pain had not gone away. CT scan shows a Jeffersonian fx of C1. The fracture points were both to the posterior arch. Called the ortho guys and they slap Miami J collar on him and send him home. I was alittle upset to say the least. So, I did some reading and any C1 fx that occurs behind the lateral masses is stable. This kid will be in the collar for 3 months, but it beats a halo for 6 months.
medic001918 Posted June 22, 2007 Posted June 22, 2007 Whit, I'm not sure what you mean by a circumflexion so I cannot comment on that. It is very rare for kids, especially this young, to end up with cervical injuries. Their bones are mostly cartillagenous at this point and can take quite a hit without any problems. Accicents that result in any form of injury are usually fatal. This is true in healthy kids. If a kid has some sort of underlying bone problem (ie osteogenesis imperfecta) then this does not hold true. Obviously I cannot comment on this kid, but I also said extremely rare (not impossible). Using the NEXUS rules, it does not sound like you can clear this kid (language barrier, can a 2 year old really tell you about midline tenderness?). Not sure where this kid falls on the CCS rules as I am not as familiar with them. Also keep in mind that not all cspine fxs are unstable (not that you can tell that in the field). I learned that this past week. We had a 24y/o who was running in some shallow water and though it would be a good idea to dive head first into the water. Imagine his surprise when a bunch of rocks jumped in his way and he hit them with the top of his head. This was at 0230 (yes, alcohol was involved). He came in about 14 hours later because the pain had not gone away. CT scan shows a Jeffersonian fx of C1. The fracture points were both to the posterior arch. Called the ortho guys and they slap Miami J collar on him and send him home. I was alittle upset to say the least. So, I did some reading and any C1 fx that occurs behind the lateral masses is stable. This kid will be in the collar for 3 months, but it beats a halo for 6 months. Great post doc. A clear demonstration that none of us are done learning, regardless of the level that we practice at. Definatly a teaching point here. Shane NREMT-P
Richard B the EMT Posted June 22, 2007 Posted June 22, 2007 I don't mind taking a few extra precautions for my patient. I would rather err on the side of caution, than not, with any kind of treatments or interventions. There are many of us who feel that way, and CYA driven or not, it is the best way. I also know a few who overdo it. The trick is finding the correct balance.
whit72 Posted June 23, 2007 Posted June 23, 2007 They explained it to me as a rotation of the cervical spine. Where the cervical vertebra lay normally in line, hers looked slipped, they didnt line up correctly, it looked as if it was putting pressure on the spinal column. I was wondering if that could be a congenital issue. Maybe were not getting the complete story as to what happened from the parents. We were waiting on word of her outcome. Usually if there is even a question I immobilize just out of precaution. I do believe we immobilize way to many pts, but we dont have any clearance protocol as of yet.
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