Saturday, November 22, 2008

Spinal? Really?

We had a patient come in yesterday on full spinal precautions after falling down some stairs.  The doctor came in the room pretty quickly and did his assessment and determined that she could come off of the backboard and c-collar.  We did so.

20 minutes later he wanted her "road tested" so we got her up and walked around the ER and everything was going ok.  She had escaped, it seemed, with some facial lacs and a couple of loose teeth.

Then the CT results came back: mandibular fracture.  This means a transfer up to a higher level ER with the proper medical staff for this fracture.  Okay.  That makes sense.

Except the part about having to send her out in full spinal immobilization.  After we have cleared her and proved that she can walk and has no neck or back pain?  Are we trying to give her back pain?  And she has a fractured mandible.  Is it really the best idea to then put a c-collar on her.  Protect the neck, sure, but have you ever noticed where the collar pushes against?  I'll give you three guesses.

So this woman who has been getting beaucoup dilaudid, which is just now barely catching up to her pain is going to be forced to be on a hard backboard with a cervical collar pushing against her broken face for a 45 minute ambulance ride?  I know that protocol is protocol, but come on, peeps!

Perhaps somebody out there in cyberland can help me understand why this is a good idea, because I just don't get it.

In the end, all I can say is thank goodness for medics who are more proficient with this task than I will ever hope to be.  I went to give the paperwork to the unit secretary and by the time I came back, she was all set to go.


Nurse K said...

Why do you have to send them in full spinal immobilization when they've been cleared? That would be like doing a medical workup on every psych transfer that's been medically cleared at the previous hospital. Mandible fracture patient should be directly admitted anyway, not go to another ER.

whitbit317 said...

I haven't been in EMS long, but haven't heard of that. I have done a transfer of a pt with confirmed spinal fracture that didn't go on a backboard...Yes, in the field it would have been back-boarded but if she's gotten up and walked it's not going to make a difference. Maybe the doc was just trying to CYA...

Evil Transport Lady said...

Sounds like somebody doesn't want to get sued;)