Category Archives: Immobilization

Category: Hypoglycemia, Immobilization, Trauma Patient   |   Date:

I have a question in regards to the hypoglycemia directive. We were dispatched to a patient who suffered a fall, with history of diabetes. Upon assessment the patient was GCS 15, answering questions appropriately and oriented to person, place, time and event, however the patient was unable to move their limbs, and had loss of sensation in portions of the arms, torso, and legs, as well as a depressed skull fracture. The patient was hypovolemic and hypoglycemic at 3.2, stating he has not been eating or drinking fluids all day. Due to a complaint of back pain and paralysis, the a c-dollar was applied and scoop was used to extricate. Because the patient was secured to the stretcher supine, treating with oral gel was not an option, and transport was a priority. Some of the symptoms exhibited by the patient are concurrent with typical signs of hypoglycemia. In this situation where the patient is NOT altered, but hypoglycemic, with sufficient suspicion to suspect that low blood sugar may be causing some of the symptoms, would it be reasonable to treat the patient with IV dextrose? How do we proceed in situations where patients may be hypoglycemic, are not altered (GCS less than 15) but are unable to tolerate oral glucose or carbs? I can see this being the case for traumas.

Category: BLS Patient Care Standards, Immobilization   |   Date:

Hello, question regarding cervical collar application. The BLS states that a collar should be applied with appropriate MOI if the Pt is altered LOC - however the Canadian Cspine flow chart states that cervical collars should only be used on stable, ALERT Pts. Is this a grey area where it is expected we use our judgement in terms of when it is appropriate to apply a collar vs manual cspine management? Or is there a certain GCS where manual cspine management is preferred over applying a collar? Thank you.

Category: BLS Patient Care Standards, Immobilization   |   Date:

Curious. Obviously, the previous standard for spinal injury was full immobilization on a spinal board. BLS v3.3 currently states that those with suspected unstable pelvis should be secured onto a spinal board or breakaway stretcher (Scoop). We are then being referred to the blunt/penetrating trauma standard. There it also states to secure onto a spinal board or breakaway stretcher, and secure the lower extremities to reduce further injury/trauma to the pelvis. My question is, what is the current acceptable standard for this immobilization as per SWORBHP. Should this be full immobilization, 4 straps, headlocks etc? I do not see this written anywhere, and just looking for clarification as no one I ask seems to know the answer. Thanks

Category: Immobilization   |   Date:

Question: In regards to the BLS version 2.0 - extremity injury, bone/joint, there's a guideline regarding elbow dislocations. It says that if we encounter an elbow dislocation with nerovascular compromise, that we can contact receiving hospital or Base Hospital Physician for advice regarding manipulation or in-line traction. In the new BLS 3.0, this guideline has been left out. Are we still expected to perform the guideline if we ever encounter this, or has this been purposely taken out? Thank you.

Category: Immobilization   |   Date:

Question: Although not employed by a service under the SWORBHP, I have been closely following this site and your LINKS newsletter. Thank you for both of these invaluable resources. After reading the most recent question regarding spinal immobilization, I had to share a resource with you that can located here https://m.youtube.com/watch?v=eM4hxuooNN0. This is a lecture by Dr. Ryan Jacobson, a former paramedic who is now medical director of Johnson County EMS in Kansas and Assistant Professor of Emergency Medicine at University of Missouri-Kansas City School of Medicine. If you have already seen it, you are familiar with its informative value. If not, I'm confident that you will find it of value. This link is unplublished and cannot be found via YouTube search.

Something that I have been wondering after viewing the lecture and statistical evidence is as follows. Hypothetically, if the current practice of securing patients to backboards increases morbidity and mortality (particularly penetrating trauma) and that there is greater spinal movement than if secured directly to the stretcher, and that no negative effects have been observed by not securing to a backboard, is it reasonable to consider foregoing the backboard as care superior to the minimum requirement as written in the BLS? Similarly to a "letter of the law" vs. "spirit of the law" question. LBBs have been contraindicated for transport in Queensland, Australia for the past five years among numerous other jurisdictions. I've inquired with my employer but was given the old "We have standards" response.

Thank you for your time and consideration on this topic. I look forward to your reply.

Category: Immobilization   |   Date:

Question: Penetrating without neurological deficits. Delay on scene to spinal immobilize?

Category: CPAP, Trauma Cardiac Arrest, Immobilization, Trauma Patient   |   Date:

Question: VSA trauma patients - chest compressions and defib is the priority for this patient. C-spine maintained manually. In this scenario, is it mandatory to apply a collar prior to a shock being delivered as the manual c-spine must be removed to deliver the shock?

CPAP- indication b/p 100 or above systolic. Contraindication is hypotension. If CPAP is applied while normotensive, can we leave the device on until they become hypotensive or we must remove when b/p drops below 100? Thanks.

Category: Neonatal Resuscitation, Immobilization, Pediatrics   |   Date:

Question: I have read the post Jan. 31 2012 in regards to R/A vs. 02 when resuscitating a neonate. It states that 100% 02 will be used after 90 sec with compressions if HR is below 60. It also states that 100% 02 will be continued until HR is normal. Does this refer to 100 bpm?

The reason I ask is if I read the flow chart to the letter at 90 sec with a HR below 60, 02 and compressions are begun. If I reassess 30 sec later and the HR has improved above 60 but below 100 (ex. 80 bpm), I continue ventilating, but do I discontinue the 02 and use R/A only? Also compressions are to be discontinued. What is stance on using a pedi-mate on a critical or VSA neonate or child (below 40 lbs)? Is it necessary as it can be cumbersome and time consuming when trying to get off scene quickly?

Category: Immobilization   |   Date:

Question: I am a recent grad from the PCP program and a new hire at my service. I have a question regarding packaging. We were called code 4 for a patient who had a fall. A call from a wrist alarm company.

Patient was found on floor by superintendent in the patient's building after connect care instructed the super. Upon arrival patient was found still sitting on the floor. The carpet behind the patient had a small pool approx. 200mls. Patient cannot remember event but is LOA x 3, good long term memory. Patient does not know how long she has been on the ground.

Physical assessments - Trauma noted on back of head. Lac (bleeding stopped) + Hematoma approx. 1 inch diameter noted on occipital area. Chest is clear, abdomen soft and non tender, pelvis stable, no trauma otherwise noted.

Equal grip strengths. Pupils PERL. Vitals are all within normal limits. Patient upon assessment has no complaints. No dizziness, no lightheaded. NO c-spine, tenderness, no back pain.

It looked as though the patient fell from height, backwards, struck head on dresser and activated wrist alarm. I decided to package the patient as a precaution. I padded the backboard with a towel before laying patient head on the board.

My question is was it necessary to apply collar and backboard this patient? Patient had no c-spine tenderness, no back pain, LOA x 3, good long term memory only issue is patient cannot remember the fall. Patient had no complaint, except the pain from the hematoma against the board.