I'm not sure 'skinny bint' is an appropriate term to use in a public forum. Your message was effectively conveyed without it.
In answer to your questions:
1: at Southampton we log roll off the spinal board ASAP, usually on arrival.
2: a doctor does supervise the log roll because a quick primary survey is needed if someone comes in on a spinal board. Senior nurses also supervise log rolls off boards for fully conscious, uncomplicated, cautiously-managed-prehospital cases.
3: good question. Any paramedics out there?
Howard
-----Original Message-----
From: Gautam [SMTP:[log in to unmask]]
Sent: 27 July 2000 21:35
To: [log in to unmask]
Subject: Rapid C-spine clearance
Follow-up to recent discussion re. C-spine immobilization....
Most people would follow the teaching that a spinal board is an extrication /
transport device, NOT suitable for prolonged immobilization (pressure sores,
discomfort etc.).
Had a well-mannered disagreement with senior (and still much-respected) sister at a
previous dept about a young lass who had been bought in with full immobilization
after a minor fall. When I arrived for work, the patient had already been on the
board, trussed up, immobile, for 3 hours. I threw one of my "usual" strops about why
she hadn't been log-rolled off on arrival, to be told that the SHO had been too busy
seeing 2 sick medical patients in the previous 3 hours and didn't have time to
supervise the log-roll.
There was no pressure on nursing resources at the time (half of them were at break).
The patient was a skinny bint, so oddly enough, all her thoracic and lumbar
vertebrae were exquisitely tender by now, ended up needing lots of dangerous XRays
to exclude #. I could have let her lie on a softer trolley mattress for a while
after we removed the board and gave her analgesia and then re-assessed, but by then,
she was so fed up she would have taken her own discharge if we hadn't given her a
difinitive diagnosis rapidly.
1) Do other departments give priority (as we usually do) to log-rolling off boards
on arrival onto something more humane (e.g. a bed of nails)?
2) do other departments encourage / allow nursing staff to log-roll off (even if not
to formally examine the back) on arrival WITHOUT waiting for a doctor to be free to
"supervise"? In my experience, doctors are rarely involved with the practical
handling of a log-roll anyway, as they are usually poised to examine the
undercarriage from the other side.
3) My understanding is that it takes a minimum of 3 persons to safely log-roll a
patient (1 for neck, 2 for body). Can one of you paramedics / pre-hospital types
lurking out there tell me how the 2 of you manage safely to get the patient onto a
board at the scene?
Dr G Ray
Staff Grade
A&E
Sussex
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