Attending patients with a suspected or “potential” spinal injuries is a common case for most paramedics. We all know that most patients involved in a car accident do not actually have a spinal injury, but protocols ussually require us to place a Cervical Collar /or Brace on our patients. Furthermore, when patients do have spinal injuries, they often have other injuries,which make positioning these patients difficult.
This is based on a recent case I attended:
22 year old, fit and healthy male with a fractured clavical (compounded) and multiple fractured ribs post fall from mountain bike. Pt walking around after incident – helmet split into two pieces.
O/E Pt alert and skin warm, pink, dry. GCS 15; Pulse rate 112 strong and regular; BP 90/42; Nil distress. Speaking in full sentences; good air entry to bases; Left equals Right lung sounds. C/O severe pain at clavical site and pain on inpiration at site of ? fractured ribs. Nil other injuries detected.
Thorough secondary survey and application of Cervical Collar. While attempting to lay patient supine (for spinal immobilisation) he became increasingly distressed and c/o SOB and difficulty breathing. The fractured clavical appeard to move distally and increase the difficulty of breathing as the patient layed back. This was resolved by sitting the back of the Ambulance Stretcher up ot about 20-25 degrees.
The patient was transported to hospital with the back of the stretcher at 20-25 degrees and the cervical/thoracic spine in allignment.
There were some discussions/arguments afterwards on whether or not this patient should have been transfered this way.
At the end of the day, laying him suppine increase the risk of airway/ventilation problems, while sitting him up slightly, still fundamentally maintained his spinal allignment.
Morphine 5mg IV was administered, but his pain on deep inspiration remained while trying to lay him supine. Eventually, he was transported with the back of the bed raised.