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Home > List Archives

Spine Immobilization

Andy Brainard trauma-list@trauma.org
Wed, 16 Apr 2003 18:47:08 -0600


The soft immobilization is there to remind the patient to hold still.=20

> -----Original Message-----
> From: trauma-list-admin@trauma.org =
[mailto:trauma-list-admin@trauma.org]
> On Behalf Of Nick Nudell
> Sent: Wednesday, April 16, 2003 6:15 PM
> To: trauma-list@trauma.org
> Subject: Re: Spine Immobilization
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> Hi Jenny
> Thank you for the clarification!
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> I certainly have had to suction emesis many times from airways of
> immobilized patients... it usually involves first a lateral recumbent
> positioning of the board, then adjusting the cot belts and using a =
pillow
> to
> maintain this position, then retrieving the suction equipment and =
using
> it.
> The patient will remain in this position until I feel the airway =
danger is
> minimized (no more emesis, arrival at hospital, or anti-emetic =
medication
> is
> administered or perhaps intubation).
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> hmmm, I would like to play devils advocate for a minute, if you don't
> mind...
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> If you feel that the patient requires a cervical immobilization device =
and
> should have lateral supports (towels/blankets, etc)... then you must =
have
> a
> reasonable suspicion of injury, right? otherwise it would be pointless =
to
> provide any immobilization...
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> So, lets say that there will be some emesis, or your driver does make =
an
> evasive maneuver (lorries, cars, kangaroos, children, sleepy driver, =
flat
> tire, wind gust, whatever)... either of those situations would =
severely if
> not totally compromise the 'soft' immobilization performed, rendering =
them
> ineffective, right? So what is the benefit of doing this at all? Is =
not
> the
> patient at greater risk from 'soft' immobilization then from none at =
all?
> My
> reasoning is this... a false sense of security would be reasonable to
> expect
> among both the provider and the patient, whom you had a reasonable
> suspicion
> of cervical or spinal injury in the first place.
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> I am very curious to hear your reasoning on this point so that I may
> understand how you overcome the risk from 'lack' of immobilization to
> patients with potential injuries...
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> Kind regards
> Nick
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> ----- Original Message -----
> From: "Jenny Moncur" <jmoncur@netspace.net.au>
> To: <trauma-list@trauma.org>
> Sent: Wednesday, April 16, 2003 4:35 PM
> Subject: Re: Spine Immobilization
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> Hi Nick,
> yep, you've got it wrong.
> IF I elect NOT to transport a patient fully immobilized on a spine =
board
> (ie, the fully conscious, co-operative patient with no obvious =
injuries,
> but
> a suggestive mechanism) I use the head rolls secured to the stretcher, =
and
> use towels and blankets to support lateral movement of the body.
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> In effect, this means that the patient is not secured at all, but is =
more
> cradled with rolls, pillows or towels etc, packed around them, not =
taped
> to
> them. They are not on a spine board, but do have a collar.
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> For ANY patient in whom I have significant concern re probable injury, =
or
> altered conscious state, or difficult transport conditions (such as =
Pret
> was
> discussing), then that patient is transported fully immobilised on a =
spine
> board, with body straps, and lastly the head taped to the board, and
> supported by head rolls. In the eventuality of a vomit, the patient is
> tipped into the lateral position to facilitate airway clearing. This =
is
> actually a pretty unwieldy process, if you have ever done it by =
yourself
> whilst also trying to suction an airway clear!
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> I certainly do NOT advocate immobilisation of one part of the body to =
a
> fixed device, but not the rest of the body (although it is seen from =
time
> to
> time). I agree that a properly immobilised patient will not be able to
> wriggle much, but they become very uncomfortable nonetheless. This is =
why
> I
> apply spinal immobilisation where I think it is indicated, not just
> blindly
> to all patients regardless of their clinical presentation.
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> In our aircraft we actually use vaccuum mattresses as a spinal
> immobilisation device. Apart from the obvious advantages of being able =
to
> mould to body contours, they do not transmit vibration from the =
aircraft
> to
> the patient. I would prefer vaccuum mattresses on the road, but they =
are
> very bulky and we do not have them yet on our road cars.
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> Hope this clarifies my statements previously
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> Regards
> Jenny Moncur
> IC Paramedic
> Victoria
> Australia
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> *********** REPLY SEPARATOR  ***********
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> On 14/04/03 at 9:27 PM Nick Nudell wrote:
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> >Jenny
> >"With regard to the 'sand bag' issue, as a paramedic I use two towels
> >rolled
> >into a cylinder and wrapped in tape.. Theses rolls are then placed =
one
> each
> >side of the patients head and taped to the stretcher. This then =
encloses
> >the
> >head in a soft support, but the patient is not himself strapped down =
to
> the
> >stretcher, avoiding the risk of a fixed head and a non fixed body
> (pendulum
> >effect)."
> >
> >If I understand you correctly (head is secured to a spinal board and =
the
> >body is not secured), then I have a couple questions...
> >What do you do if the patient suddenly decides to vomit?
> >What if your driver decides to make an evasive maneuver?
> >I am not aware of this particular method being taught in any of the
> >available trauma courses in the States, is it in Australia?
> >Is there any research to validate this method?
> >
> >Just a comment in response to "even a short trip on a spine board is
> >awfully
> >uncomfortable, and makes the sore bits sorer and the patient more
> inclined
> >to wriggle.":
> >While we agree that it is generally uncomfortable, I do not agree =
with
> the
> >assertion that providing less strapping so that a patient may move =
freely
> >is
> >providing any meaningful purpose. With a properly secured patient, =
they
> >will
> >not be able to 'wriggle' even if they want to. This I assert is the =
goal
> of
> >spinal 'immobilization'.
> >
> >Perhaps I am not picturing your immobilization method correctly.... =
but
> the
> >picture painted in my head is not of spinal immobilization but of =
skull
> >immobilization and spinal mobilization... please correct me if I am
> wrong.
> >
> >Kind regards
> >Nick
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> Jenny Moncur
> 'Mullungdung Arabians'
> Willung South, Victoria
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> Situated near the beautiful
> Mullungdung State Forest in
> Gippsland
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> ph/fax  (03)  5194 2226
> email   jmoncur@netspace.net.au
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