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Spinal Injuries
Published in Ian Greaves, Keith Porter, Jeff Garner, Trauma Care Manual, 2021
Ian Greaves, Keith Porter, Jeff Garner
A limited log roll should be performed. This allows assessment of the back and spinal column and the removal of the long spine board or scoop if one is present. Before the log roll is commenced, MILS should be instituted before blocks and straps are removed. The collar can also be removed at this stage to check the neck for any deformity, tenderness, bogginess or spasm. To examine the remainder of the vertebral column, the patient must be ‘log rolled’. This technique requires at least 5 people. One person, the team leader, is responsible for maintaining the in-line stabilization of the head and neck and coordination of the log roll. A second person holds the patient’s shoulder with one hand and places the other hand on the pelvis. The third person holds the pelvis with one hand and places the other hand under the patient’s opposite thigh. The fourth person places both arms under the opposite lower leg and supports it during the roll. The fifth person is responsible for examining the back, conducting a rectal and perineal examination, observing pressure areas and clearing debris. Further staff will be needed to assist with the removal of a long spine board or scoop. The team leader must give clear audible instructions and indicate in advance what these will be. For example: ‘We are going to roll to the patient’s left. The instruction will be ready, brace, roll. We will roll on the R of roll’. The roll should be no greater than is needed to ensure an effective examination of the back.
Thoracolumbar spine injury
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Anesthesia for Neurotrauma, 2018
Monica S. Tandon, Priyanka Khurana
However, prolonged immobilization on a hard surface causes discomfort to the patient and also predisposes to the formation of decubitus ulcers; therefore, vulnerable areas should be well padded and the patient should be removed from the long spine board as soon as it is feasible. If this is not possible within 2 hours, “logrolling” the patient should be done every 2 hours, while maintaining the integrity of the spine.
The Use of Ultrasound in Trauma
Published in Armin Ernst, David J. Feller–Kopman, Ultrasound–Guided Procedures and Investigations, 2005
Carlo L. Rosen, Carrie D. Tibbles, Jason A. Tracy
Using ultrasonography in the trauma patient has several potential advantages. Bedside ultrasonography can be performed significantly faster than a portable chest X-ray and can expedite the placement of a thoracostomy tube prior to return of the initial chest X-ray results (43). US can also accurately detect a smaller amount of pleural fluid than a chest X-ray. US detects as little as 20 ml of fluid, compared to a minimum of 175 mL on a supine chest radiograph (17,47). An upright chest X-ray can detect 50 to 100 cc of pleural fluid. However, the majority of trauma patients are immobilized on a long spine board and cannot be repositioned because of other potential injuries (48). US can also be used to distinguish pleural effusion from pulmonary contusion if the supine chest X-ray is equivocal (44).
Compulsory Use of the Backboard is Associated with Increased Frequency of Thoracolumbar Imaging
Published in Prehospital Emergency Care, 2018
Brian M. Clemency, Christopher T. Tanski, Jennifer Gibson Chambers, Michael O'Brien, Andrew S. Knapp, Alexander J. Clark, Patrick McGoff, Johanna Innes, Heather A. Lindstrom, David Hostler
Like most states, New York had traditionally employed a Spinal Immobilization protocol that included compulsory backboard application for all patients with suspected spinal injuries. In late 2015, based on the harms associated with backboard use and the low percentage of patients who actually had an unstable spine injury (22), New York State introduced a new “Spinal Motion Restriction” protocol. The new protocol states that when a spinal injury is suspected “a long spine board is one of multiple modalities that can be used to minimize spinal movement” (23). Under the new protocol, providers are now empowered to choose the method that they feel is best for moving the patent given the circumstances. In the case of patients involved in motor vehicle collisions (MVC) with a suspected spinal injury, providers now most often place a cervical collar and assist the patient in a stand and pivot maneuver from the car directly onto the ambulance stretcher.
Spinal Motion Restriction in the Trauma Patient – A Joint Position Statement
Published in Prehospital Emergency Care, 2018
Peter E. Fischer, Debra G. Perina, Theodore R. Delbridge, Mary E. Fallat, Jeffrey P. Salomone, Jimm Dodd, Eileen M. Bulger, Mark L. Gestring
All patient transfers create potential for unwanted displacement of an unstable spine injury. Particular attention should be focused on patient transfers from one surface to another including, for example, ground to ambulance cot. A long spine board, a scoop stretcher, or a vacuum mattress is recommended to assist with patient transfers in order to minimize flexion, extension, or rotation of the possibly injured spine.