Essay on Pre-Hospital Immobilization of Trauma Patients

10. Taking S.P.’s RA into consideration, what interventions should be implemented to prevent complications secondary to immobility?

The nurse was asked what was hurting and "she replied that she was having head pain and a server headache", the next question which was asked what time the incident happened, and "she replied to it that it had happened around 16:30 hours and has been sitting here to see if the pain would go away", the next question which was asked if she wanted to go to the hospital, "she replied that she wants to go", The EMS crew then told the nurse to get up and move over to the stretcher located along the side of her and,"she replied that she did not want to go by a stretcher and, but she would prefer to walk out to the

The trainer then started cutting off all equipment. Once the ambulance arrived, an IV was put into his arm but the pressure applied to Mr. Malarchuk’s neck was never left without pressure until he was in doctors’ hands at the local hospital.

In the emergency room, Rudd was connected to the cardiac monitor, labs were drawn and a 20-guage peripheral IV was started in the right arm. An IV infusion of nitroprusside was started and vital signs were recorded periodically. The Pain was assessed using a PQRST pain assessment method and Rudd rates throbbing pain bilaterally in the head with a pain score of 8 that aggravates with moving and does not radiate to elsewhere other than the head. The orthostatic BP shows no changes. The E.D physician decides to admit Rudd in CCU to further monitor his blood pressure and watch for any signs of organ damage. The E.D physician writes an order for pain management and transfer to CCU. The ER nurse

Haskey was very upset by this, she was under the impression that Mr. Haskey was going to Arbor Ridge for rehabilitation. Mr. Haskey retorted by saying “Arbor ridge was full so they are putting me here”. Mr. Haskey was very adamant of this and insisted in being put in his own bed. Mrs. Haskey was very distressed by this and stated “I can’t take care of you, I’m not a nurse and I don’t know how to help you and if you fall I cannot possibly lift you up”. While on the way out S/O EMT Perez was very unsure about the situation at hand and stated to Mrs. Haskey that he would immediately report this to his supervisor. After S/O EMT Perez cleared he talked to his supervisor S/S EMT Salamy about the situation and eventually found out after following up with the Arbor Ridge Nursing staff that Mr. Haskey had a room ready for him and that the staff were waiting for his arrival. After receiving this news S/O EMT Perez, S/O EMT Ayesu and S/S Salamy reported back up to CT-403 and S/S Salamy explained the situation to Mrs. Haskey and apologized for the mis-communication error that had happened at some point during the return process. S/O EMT Ayesu and S/S EMT Salamy escorted Mr. Haskey to his room at Oak Grove 3205 and with the help of S/O EMT Perez and the nursing staff placed MR. Haskey in his

The day started off normally. I got to the station early at 0645 and started to talk to some of the guys working. There were a couple guys I just met that day. Then I started to get all my stuff ready for the day. I put all my gear on the ambulance and started on the daily checks for our rig. The daily checks consist of checking the lights and sirens, fluids, and making sure all our supplies are in the compartments and in the bags. As I started going through the monitor bag with the electrocardiogram (EKG), we get a call to a male in his 40’s unresponsive and not breathing. Everyone jumped into the rigs and we rushed off to the scene code three. We were en route to a residence to the south. When we arrived we looked for the address but it did not

- Examine the patient for other injuries, such as a neck injury that may have occurred as a result of the backward motion of the neck

Spinal immobilization has been a common practice in Emergency Medical Services. The act of spinal immobilization is normally used when a patient has suffered a significant trauma. Spinal immobilization consists of securing the body to a rigid, long spinal board, securing the neck with a cervical collar, and then lastly, securing the head to the board between towels or wedges. Initially starting with the effectiveness of backboarding, continuing into the vital functions that backbaording can impede and finalizing with the vacuum mattress versus the traditional backboard. Ultimately, spinal immobilization of all trauma patients can do more harm than good, and all cases should not be fully immobilized.

The article discusses the importance of leadership and teamwork in trauma and resuscitation. It describe how leadership and leadership styles affect patient care, and looks into figuring out how to train future physician leaders. The article states that “according to the Centers for Disease Control and Prevention, unintentional injury remains the leading cause of death in people under 44 years of age and the fifth overall cause of death in the United States.” Furthermore, stating that the lack of proper leadership contributes to this cause. An example used in the article to describe a common seen lack in leadership was an ER physician and a Trauma physician working parallel of each other trying to execute their own plan. Although it may seem

In terms of time efficiency, methods used to evaluate the cervical spine in victims of trauma, at present, an area of controversy. Prolonged times of radiographic or CT examination which may delay treatment, can adversely affect the patient (Schenarts, et al, 2001). In most situations, plain radiographs are usually immediately available while CT scan could have limited availability during busy hours or after-hour time as it needs time to heat or cool down the machine. Although radiography has been the mainstay for initial evaluation, the growing number of reports on the efficacy of helical CT has led many authors to suggest that it is superior to radiography for this purpose (Holmes, Akkinepalli, 2005).

The NEXUS criteria can assist in determining whether a cervical collar is indicated for immobilisation. According to this criteria a patient who has been involved in a motor vehicle accident would require a cervical collar to be applied if they report any midline cervical tenderness on palpation or if the patient has a neurological deficit for example paraesthesia, central cord syndrome or radiculopathy. If the patient was intoxicated from any substance, a collar to immobilise the neck would also be indicated, as this may impair their ability to recognise pain and injury. If the patient has an altered mental status being GCS less than 15 or less than normal baseline if known otherwise. If the patient has a painful distracting injury a cervical

This wide spread belief that long board immobilization is the best course of action for any patient with the slightest chance of a spinal cord injury seems to be false. Although hard to imagine this treatment not only puts your patient at a greater risk of secondary harm, but may to a certain extent cause your patient direct injury. "When comparing neurologic out comes from patients treated with immobilization to those who were not, at comparable facilities and by comparable physicians, there is However when we consider the aspect of the spine in question and the data used, we should also recognize that in the modern prehospital system the high cervical spine patient would be transported and arrive at definitive care in a condition not seen in the developing nation. This is likely due to the fact that initial presentation of the high cervical injury and the potential for rapid deterioration, may result in the patient not being transported by any means to the care facility, thus skewing the results of this study. Hidden wounds, difficulty with the airway and breathing assessment, and poor provider use are all risks and limits to this piece of equipment that must be considered and understood when utilizing cervical spine immobilization techniques. Taking this all into

According to Vickery (2001) however, the spinal board is considered to be the gold standard for spinal immobilisation during the pre-hospital phase of trauma management. For some patients, effective spinal immobilisation is beneficial and can also be vital in preventing the devastating effects of cord damage however it has been suggested that for many the excessive use of this preventative measure may not be prudent or necessary. It has been estimated that over 50% of trauma patients with no complaint of neck or back pain were transported with full spinal immobilisation (McHugh & Taylor 1998). Inappropriate spinal immobilisation may lead to patients experiencing unnecessary pain, skin ulceration, aspiration and respiratory compromise, which in turn may lead to further unnecessary procedures, a longer hospital stay which then incurs increasing costs to the National Health Service (Kwan, Bunn & Roberts, 2001). Shooman & Rushambuza (2009) report that immobilisation is a crucial part of the management of a trauma patient. They believe that if the mechanism of injury is uncertain, the patient should remain immobilised until further imaging even if there are no symptoms of spinal instability after log rolling. However, in a recent study by Pandie, Shepherd & Lamont (2010) they concluded that on its own, standard

Another study that is supportive of the hypothesis that spinal immobilization is detrimental to trauma victims examines the efficacy of spinal immobilization practices during extrication. In a high tech proof of concept study conducted by Dixon, O’Halloran, Hannigan, Keenan, & Cummins, it is concluded that current evidence base for spinal immobilization techniques during prehospital extrication is poor. They further emphasize that traditional prehospital extrication techniques used by the emergency medical services (EMS) have evolved through pragmatism rather than being introduced following evidence-based scientific research. To prove this they used high speed cameras and biomechanical markers to measure the range and degree of motion that

There are notions among patients that being in the hospital is the time to rest. While getting rest is important in the healing stage, too much bed rest can cause complications. Early ambulation is not a new topic. Unfortunately new evidence suggests that the earlier a patient is out of bed and walking, the better their outcome will be. Early ambulation is not about how quickly a patient can move, but how often they move and the quality of those movements. Even if a patient is unable to physically walk, simple movements such as sitting up in a chair/wheel chair or dangling their legs is more beneficial than lying in bed. Some of the most common complications due to immobility include loss of muscle strength, deep vein thrombosis, contractures and soft tissue changes. While early ambulation may be contraindicated in unstable patients, early ambulation decreases