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Tue Jun 6 19:35:56 BST 2006

Bren:

Airway Breathing Circulation....

----- Original Message ----- 
From: "Bren" <brendan at emstraining.co.za>
To: "Trauma &amp; Critical Care mailing list" <trauma-list at trauma.org>
Sent: Tuesday, June 06, 2006 6:54 AM
Subject: RE: Spinal immobilization

>I must add to this... we work in a situation where there may be more than
> two or three patients in a vehicle at a time. How does the EMT working 
> alone
> deal with on aspirating patient whilst controlling arterial bleeding on
> another patient? These are the realities of where we work, and the
> environment we're in. our decision to train students in lateral
> immobilization may be anecdotal to some extent. But how much gastric 
> content
> is too much?
> We give students the option of normal supine transport and in no way force
> them to use the lateral method but we've had so many people come back to 
> us
> with positive feedback that it makes it an interesting case for study.
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]On Behalf Of Bren
> Sent: 06 June 2006 12:18
> To: Trauma &amp; Critical Care mailing list
> Subject: RE: Spinal immobilization
>
> It's an interesting thought...
> Our problem is that the injured or ill patient is inevitably nauseous and 
> if
> he's been immobilized and strapped to a spine board he has no way to 
> protect
> his own airway in the case of active vomiting. He can't just sit up can 
> he?
> He's strapped down! And just how quickly does a patient vomit? If we take
> into consideration that, in addition to being ill or injured, he suffers
> from motion sickness (tied down travelling head first in a large diesel
> ambulance, anxious, probably slightly shocked) how fast can the ambulance
> technician alone in the back with him lean over and turn him lateral when 
> he
> does actively vomit?
> In the case of a more serious injury with a patient with a decreased level
> of consciousness, he can't even tell you that he's feeling nauseous and 
> may
> give absolutely no warning that he's about to vomit.
> Beyond that is the patient who has a seriously diminished GCS (6 - 12 out 
> of
> 15) who may passively aspirate stomach contents into his airway. If lying
> supine... aspiration Pneumonia is a no-brainer.
> If the EMT looks away for a second or (lord forbid) doesn't pick up that 
> the
> patient has aspirated... on top of that is the fact that a suction unit is
> only effective if we leave the catheter in place and suction constantly...
> Our EMT-B equivalent have only Guedel Airway as an airway adjunct and may
> suction... beyond this it's manual airway manoeuvres. No more than that.
> And if there's no logic to it why is the "recovery position" so strongly
> advocated in non trauma patients with decreased level of consciousness?
> Thoughts please??
>
>
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]On Behalf Of p.bjorn
> Sent: 06 June 2006 07:58
> To: Trauma &amp; Critical Care mailing list
> Subject: Re: Spinal immobilization
>
> Bren,
>
> I think this is an over-solution.  I doubt it's been studied, because it's
> of no logical benefit: if your spinal immobilization is adequate that you
> can turn the patient on his side for the entire transport, why not just 
> let
> him lie supine and turn him as needed?  Being strapped to a backboard is
> uncomfortable enough without hanging in a half-turn for the duration.  If
> you must pursue this odd course, I'd suggest requiring that all providers 
> be
> immobilized for twenty minutes both ways as part of their training.  I 
> think
> you'll find the enthusiasm waning.
>
> And by the way, secure airways can be properly maintained in a BLS
> environment, if you're confident in your BLS.
>
> Pret Bjorn, RN
> Bangor, ME USA
>
>
> ----- Original Message -----
> From: "Bren" <brendan at emstraining.co.za>
> To: <trauma-list at trauma.org>
> Sent: Tuesday, June 06, 2006 6:07 AM
> Subject: Spinal immobilization
>
>
>> Hey, we're having some really good arguments regarding the pre-hospital
>> immobilization of trauma patients.
>> The big concern is one of airway management. Since most of our ambulances
>> run with primarily Basic Life Support crews (equivalent of EMT-B) and are
>> not trained in advanced airway management, what methods do we have of
>> properly maintaining a secure airway?
>>
>> The argument seems to center around Immobilization on a long spine board
>> with full head immobilization, using a commercial head block device and
> then
>> turning the board, patient and all, into a lateral position to minimize
> the
>> chances of aspiration. Purely anecdotal perhaps, but it appears to be 
>> very
>> effective if the pre hospital providers ensure that the immobilization is
>> correct. We have come up with a method that prevents lateral movement of
> the
>> body and secures the patient to the board and allows little or no lateral
>> movement of Cervical Region. Does anyone on the list know of any studies
>> conducted in this regard? Currently we're training people to place all
>> spinal (or possible spinal) patients in the lateral position after
> ensuring
>> proper immobilization
>>
>> Your comments are awaited with baited breath!
>>
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