I have many questions regarding the nursing care of the patient with a cspine fx (especially unstable fx) in ICU. I have never done this yet, but am already done with orientation in the neuro ICU, and i fear doing harm. My preceptor told me that if i ever got an unstbale C spine fx that I shouldn't ever move the patient at all untill he had corrective surgery (even though this could be days). She said that you just hope he doesn't poop. My question is, is the back board removed in the ED (I know that is a stupid question and I am sure it is) but if so, how do you go to MRI and such. I would really be interested in any input. I have ordered Joanne HIckey's book, but it has been over a week and it's not here yet. Research on google is difficult, as I keep getting pre-hospital care info and MD care. I promise when i get my book I'll stop asking you all so many questions. I would really appreciate any input on standards of care and protocals for care of the c spine patient.
Last edit by dorimar on Mar 11, '06
Mar 11, '06
If you have to move them you have to. I.e. poop, vomit, etc. However, when we have an UNSTABLE (yes, unstable in caps). We don't move them unless absolutely necessary. We had a guy about 6 months ago that was very unstable c3 or 4 I think. Anyway, he started freaking out cause he couldn't take lying on his back anymore. I stayed with him in "intense" therapeutic communication to get him to lay still, while the nurse got an order for Ativan.
Definitely log roll with one person just to manage the neck and an several others to manage the rest. Don't have lots of experience yet, (1 year as tech and 2.5 months as nurse) so I'm sure you'll get better/more advice from others.
In addition, these patients need lots of supervision. As they can injure themselves so easily. My unit has an observation room that has one nurse or one tech present at all times.
Last edit by CarVsTree on Mar 11, '06
Mar 11, '06
I'm fairly new too (2 years). I make sure I ask the neurologist. I had a patient the other day that was in cervical traction and a collar and wouldn't have surgery to stabilize his cervical spine for a few days. I was told in report not to move this guy no matter what. I'm thinking 'great, what am I supposed to do if this guy takes a dump?' I asked the surgeon and he told me that I could turn him to change sheets and for ADL's, just make sure I log roll him with help. That's what the docs get paid for, pick their brain.
Mar 11, '06
Make sure that you have either a physcian handling the neck or a nurse with much experience. You want one person actually at the head of the bed providing support for the head and C-spine, then several others take care of log-rolling the patient. If it is a very new and unstable fracture, get the neurosurgery resident there, the intensivist, or which ever doctor is on that is covering your unit. You do not want to take on this responsibility yourself, even if the doctor tells you to go ahead and do it.
Best thing to tell the patient is that you are going to roll him all in one step, just like you were rolling a log and that they should not try to help at all. That is the most important piece of information to give you.
Mar 13, '06
You would still need to log roll your patient at some point if you have an experienced team and use the correct techniques the patient should not be in danger.
Apr 14, '06
I am very impressed with your facility. I work in a big inner city level 1 trauma teaching facility neuro unit (X2 months) and have NOT seen a doc or resident yet. The trauma residents don't even call back sometimes. It sucks, because I am used to so much more autonomy. I always had to trouble shoot every thing BEFORE I called the doc. Now I am not even allowed to order an abg, because, supposedly the docs are availabe at all times to decide on this nescessity (and yet they don't call back). I had to laugh at "make sure you have the doc at the head". I have finally decided to trust my judgement and get out. I have doubted myself because I am new to neuro, but have had a feeling all along that I was right about the place, and glad to have it confirmed by these posts from other teaching facilties where they seem so much better. I have had several travelers tell me "this is a teaching facility, but it is not a real teaching faciltiy". The only thing i have to say about the situation where you are not allowed to act on your judgement is "God bless the E ICU"! I also have to say to any of you young nurses out there who have only worked in one place and no where else, and think you know it all: You don't know it all, & if someone asks a question about protocal of removing a back board without an order, or don't all spinal cord injuries have a steroid drip protacal, or whatever question stemming from concern for the patient, they are asking because different places and docs and protacals do things differently. It doesn't mean they are stupid if they ask. I think the nurse that does things just because "That's the way we do it here and always have" without questioning & then bully's those who do not automatically know their protocal (despite how lax it might be), can be a danger.
Jun 26, '06
The patient's neck should be stabilized in some manner (Miami J collar, traction with tongs, halo or surgically stabilized. To not turn a patient for even less than 24 hours can lead to decubitus, atelectasis, and all the other respiratory and circulatory problems that quadraplegics/paraplegics are so prone to. Talk to a Clinical nurse specialist or your PPM (professional practice committee) to develop a standard of care for these patients. Or, transfer them to a facility that has one in place that will reduce their morbidity & mortality.
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