VermontEMSDistrict3SpinalImmobilizationProtocol：佛蒙特州的EMS区3脊柱固定协议.pptVIP

Why do this? Current practice it totally variable Clear, reproducible local standard Easy tool to measure compliance Formal training in cspine evaluation Can modify in future to incorporate new data How do we decide in the ED? Two main studies NEXUS Canadian C-Spine Rule Practice exam! Demo up front 2 people Same every time you do it You won’t forget a step that way. Stop at first positive sign and immobilize. Don’t do ROM if they have pain, n/t, or other sign! * * * * * * * * * * * * * * * * * Distracting Injury Of variable use Some injuries are more distracting than others Not part of Canadian C-S rule Is part of NEXUS, but was left up to the attending physician to define it Part of EMS criteria for now Less used in ED assessment now Presence of Distracting Injury Any injury that produces pain that impairs the patient’s ability to appreciate other injuries: Head injury Long bone fractures Large lacerations Abdominal or pelvic pain Large burns Medical conditions: cardiac pain or difficulty breathing This is an equivocal and poorly defined concept Will remain a part of our EMS algorithm. Subjective Neurological Deficit Patient complains of numbness, tingling, pins and needles, shooting arm pain, etc. Patient complains of decreased strength or decreased ability to move limbs Any patient who describes transient numbness and tingling should be fully immobilized even if symptoms have resolved Subjective Spine Pain Patient complains of cervical or thoracic spine pain. “Do you have any neck or back pain?” If yes, immobilize. Objective Neurological Deficit Patient cannot move an extremity Patient’s extremities are flaccid (Patient has abnormal motor reflexes) Generally: grips, push pull, flex/extend feet, intact gross sensory in all 4. Objective Spine Tenderness Patient has tenderness upon palpation of the cervical or thoracic spine. You must palpate each cervical and thoracic vertebra Continue down spine Apply an axial load to top of head Other Exam Abnormality Your phy