Spinal Injuries
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It's awesome that the Epic Rescue thread in the Lost and Found forum drifted (partly) on to spinal injury. It's an important topic for this community as we will always be the first ones taking care of our own when they get hurt. Here's some info to add to the discussion: |
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Yes thought: Get some frigging WFR training. |
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For context, the Epic Rescue thread had some good posts on spinal injuries and whether or not the injured climber should or shouldn't have been immobilized or SAR called or not. |
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Obviously the C-collar has it's drawbacks and possible adverse effects. What's important to note though, I feel, on a forum like MP, is that one of the sources the OP cites still recommends using the c-collar in difficult extractions and for "stabilizing the neck during stretcher carrying in difficult terrain." I've never been involved in an extraction with a liter where the patient was able to lie perfectly still, conscious or not. |
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Yes, a very interesting topic. After reading Jim's College of Emergency Physicians take on Spinal Injury Management link in the other thread, I realized the changes discussed are likely of greater impact to the urban responder who may be trained immobilize everyone and let the hospital sort things out. |
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As an urban professional having treated // extricated critically ill patients in wilderness settings I want to put it out there that cervical collars can play a huge role. There is a shift in not boarding everyone and selectively collaring. |
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Jim R wrote:My thoughts: If the injured is fully alert and does not have other incapacitating injures, does not have new neurologic deficits based on your assessment and is able to walk, its likely safe for them to carefully self evacuate. They may still have a stable spinal fracture. They should seek medical attention post evacuation if theres any question. If anything changes during evacuation, stop, reassess and reconsider your options which may include calling for a formal rescue. Spinal fractures are common. Associated spinal cord injuries are rare.Thank you very much for validating some of what I already had presumed and posted. I have done a basic wildness first aid course but I would say that my most of my medical knowledge has come from experience an (un)common sense. I've broken enough bones over the years that I'm happy with my self assessment. |
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Not if they have any spinal tenderness! You might actually become paralyzed from these kinds of decisions, especially if you think oh I have a WFR I can totally call neck/back pain insignificant. Reading this is kind of terrifying |
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I really appreciate the professional advice everyone is offering on this topic. |
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For an improv collar consider carrying a SAM splint - they're great. Use them every day at work for fractures and have seen them used as improvised collars. For other improvised collars consider the bill of a hat with the concave section under the injured persons chin, padding on each side and gentle dressing holding it all together. Don't want anything tied around the neck too tight! |
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Thanks for answering my question Medic 741. |
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Jim R wrote:Cervical collars do not immobilize the spine. They may cause vertebral distraction (axial stretching) They do increase intracranial pressure. They make it harder to maintain the patients airway or for the patient to maintain their own airway. Theres nothing in the medical literature that supports their use.This is the worst, must uninformed piece of information I have seen to date. Does it eliminate all motion? No. Does it inhibit rotation, flexion, extension, and side-bending? Greatly. To have a high cervical fracture and not have a collar put on is crazy. Maybe that's why they follow up with "actually, in bad situations for carrying, maybe its a good idea." Because the gross immobilization that a collar gives is important. |
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This notion that cervical collars increase ICP is interesting. Where is the data on this? Direct measurement of ICP is difficult to impossible. I hope that someone isn't trying to place pressure catheters in the cerebral ventricles of everyone who ever had a cervical collar. The disruption to venous return would be minimal. If you are compressing the neck veins that much you are most likely also occluding the carotids, which you would hopefully notice when your patient passes out. |
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Tom-onator wrote:Thanks for answering my question Medic 741. I see the importance of having the patient focused on remaining perfectly immobile and the baseball cap under the chin idea is brilliant. Are there any statistics on climber/hiker falls where the person sustained further injuries due to being transported improperly after a fall?There aren't a lot of statistics because it is really difficult to tell what injuries came from the fall, what injuries were due to natural swelling of the injured area after the fall, and what injuries were from improper transport. |
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Medic741 wrote:Not if they have any spinal tenderness! You might actually become paralyzed from these kinds of decisions, especially if you think oh I have a WFR I can totally call neck/back pain insignificant. Reading this is kind of terrifyingSince when did anybody call neck/back pain insignificant!? But neck and back pain come in all sorts of flavours. I can get a sore neck from belaying.... |
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JBennett wrote:Direct measurement of ICP is difficult to impossible. I hope that someone isn't trying to place pressure catheters in the cerebral ventricles of everyone who ever had a cervical collar.Catheters you say? A few links deeper into the SCANCRIT blog discovers the article below, from which references 107-112 are used to support the claims of increased ICP. The studies are few, and the populations obviously small (n=30, n=10, etc). Reference 112 measures the internal jugular vein dimensions via ultrasound, the others focused on measuring pressure. Have a skim, it'd be good to get your comments. ncbi.nlm.nih.gov/pmc/articl… |
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Medic741 wrote:Finally - if you do have to rappel with a possible spinal injury patient practice a tandem rappel. This way you are with them to support neck/back and be capable of responding to changes in patient status during the rappel.Have you tried conducting a tandem rappel while supporting a victims neck/back? ... with equipment that would be available on a 10 pitch free climb? I've practiced tandem rappel more than once. My initial thoughts are this: if the neck/back needs support to prevent a spinal injury, it is probably not a good idea to rap (generally speaking). |
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Medic741 wrote: especially if you think oh I have a WFR I can totally call neck/back pain insignificant.Whoa, where the hell did that come from? Why in the world would propose that's what a WFR would think? |
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Tom-onator wrote:I really appreciate the professional advice everyone is offering on this topic. As far as appropriately sizing a collar goes, any rules of thumb applicable when improvising a neck collar? I'd imagine one could use the padded hip belts off a backpack to stabilize the head, but how can you determine if the size is "correct"?Rolled fleeces/sweatshirts around the back of the neck and crossed over the chest work reasonably well. Patient can hold the ends at maintain reasonable stability. This should be one of your last options to consider however - cervical collar definitely ranks above! Example: books.google.com/books?id=2… |
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patto wrote: Since when did anybody call neck/back pain insignificant!? But neck and back pain come in all sorts of flavours. I can get a sore neck from belaying....Going out on a limb, I think he meant "spine pain" - pain / tenderness upon palpation if the spine itself. That's what I've always heard from instructors in response to questions about what pain / tenderness is significant. Maybe someone with training higher than WFR can clarify. |
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Bill Lawry wrote: Have you tried conducting a tandem rappel while supporting a victims neck/back? ... with equipment that would be available on a 10 pitch free climb? I've practiced tandem rappel more than once. My initial thoughts are this: if the neck/back needs support to prevent a spinal injury, it is probably not a good idea to rap (generally speaking).That's what comes to mind for me as well. With the bumping / jostling that could occur in any sort of raising / lowering, I'd consider this to be a last option, for when other more critical issues become a higher priority. Waiting for well-equipped rescuers is a small price to pay for preventing lifelong disability. What stands out in my mind around this type of injury is a story I heard from one of my instructors: motor vehicle accident victim thought he was unhurt and stood up. When he did, it caused spinal cord injury, and he was instantly paralyzed. Having spent a lot of time with an SCI patient and witnessing the enormous effect it had on her life, I would hate to bring that on someone by moving them when I shouldn't have. |