FollowUp to "Was I Out Of Line?" - Walking C Spine Injuries

TazziRN, RN · Jul 15, 2007

Lots of people show up in ERs ambulatory, c/o neck pain, and end up having a vertebral body fx. They are stable in that the vertebra isn't transected so the cord is fairly safe, but it's still considered an "Ohmygawdgethiminc-spinerightnow!!!" injury.

SK-222 · Jul 15, 2007

I had 4 thoracic vertebral fractures before and thank God I didn't have devastating consequences after seeing the x-rays. In fact, I had driven myself in (lonnng story in archives of this msg board). Anyways, without the cord inpinged on at that immediate time, I was a walking wounded myself.

Now what used to (still does) frustrate me; when I worked EMS and now ski patrol, on pt.'s w/spinal precautions we put the collar on, etc. Why is it the minute they get to the ER, time and time again I've watched the ER doc palpate "ok, does that hurt here? No, good, here? No, ok, I'm taking the collar off, just lay still" :uhoh3:

prmenrs, RN · Jul 15, 2007

"...Now what used to (still does) frustrate me; when I worked EMS and now ski patrol, on pt.'s w/spinal precautions we put the collar on, etc. Why is it the minute they get to the ER, time and time again I've watched the ER doc palpate "ok, does that hurt here? No, good, here? No, ok, I'm taking the collar off, just lay still"...

Why, it's those X-Ray doc eyes, don't you know???

Tweety, BSN, RN · Jul 15, 2007

You can walk about with transverse process fractures, and other fractures, of the c-spine without any kind of stablization. The c-spine is very good at protecting itself with muscles, ligaments, tendons, etc. that hold it in place nicely.

If there is any displacement, disc protrusion, cord involvement etc. one might have to wear a hard colar, or even a halo, or have some kind of surgery. There are several scenerios when one has a c-spine injury.

Never ambulate a patient s/p c-spine injury without an o.k. from the doc, preferably a neurosurgeon. Whenever I have a patient that is on the floor status post mva or assault or whatever if they complain of neck pain, I slap a cervical colar on them and institute bedrest until I get a further o.k. from the doctor.

icuwant2rn · Jul 15, 2007

This was years ago, but there was a lady who walked 1 mile after a MVA to my cousins house to use the phone (this was in the boonies, so no cell phones) who has broken her neck!

Still talked about by some of the old EMTs who can't believe she didn't wind up paralysed.

Anyway, the point is is that it is possible to have a fx cspine and be able to ambulate.

vampiregirl, BSN, RN · Jul 15, 2007

Is there really such a thing as walking C spine injuries? It sounds incredibly dangerous and sound like it could have devastating consequences.

In the land of EMS, we sometimes run into patients who have a "distracting injury"... any injury that captures the patient's attention. This could be pain somewhere else or something involving lots of blood. Also, the adrenalin rush from the incident, concern over others involved in the incident, or umm, other substances that the patient may be under the influence of. Either way, the patient's attention is drawn away from the neck/ back pain. Our protocol is to take full c-spine precautions immediately if a patient complains of neck/ back pain regardless of whether the patient is up and walking around or if we notice a significant mechanism of injury. I've backboarded many patients standing up. And yes, occasionally a fracture has been found.

woody62, RN · Jul 16, 2007

Lots of people show up in ERs ambulatory, c/o neck pain, and end up having a vertebral body fx. They are stable in that the vertebra isn't transected so the cord is fairly safe, but it's still considered an "Ohmygawdgethiminc-spinerightnow!!!" injury.

In 1972 I suffered a fracture of C4 with minimal displacement. I ended up with a halo for three months. My Mom said it was likely the only time she would ever see me with a halo. Once the halo was applied I was allowed out of bed. You haven't lived until you have had this experience, believe me.

In 1996 I suffered herniation of C4-5,5-6,6-7 disc. I'll take that, with the pain over a halo any day.

Woody:balloons:

TrudyRN · Jul 16, 2007

Wow, I am amazed. I sure never knew all of this.

P_RN, ADN, RN · Jul 16, 2007

I had a patient who was found totally unable to move for a minute or two, then "suddenly" all problems are gone. Doc said it was a jumped facet of the vertebrae.(Mr V jumped back in place) Oh yes, he got a halo, we went ahead and notified the prosthetist he might have a customer when we got the call.

JaneyW · Jul 16, 2007

I have had serious disc herniation and am s/p cervical discectomy with fusion at c 6-7. I still have protrusion at c 5-6 and 4-5. Any inflammation--even a cold virus--can bring on some horrible nerve pain/function issues. Let me warn you that my neck never did hurt--not at all. People with nerve impingment in the neck will have sx in their arms and shoulder blades. My elbow and wrist were very painful as was my shoulder blade on the one side where the nerve was affected. Just because there is no neck pain doesn't mean there aren't serious things going on in the neck.

bigsyis · Jul 16, 2007

Many years ago when I was Charge in ER on 4th of July, we had had a horrendous day. At 7 p.m. I went out to Triage a man who came walking in wearing his bathing suit, accompanied by his wife. His complaint was a laceration to top of his head. The odor of ETOH would about knock you down. The wife said he had been drinking beer and peppermint schnapps all afternoon.:uhoh21:

He bent his head over for me to see the lac and at the very back of the top of his head he had about a 4 inch horizontal lac. It wasn't bleeding, and when I looked more closely about the hair, what did I see but SMALL STONES EMBEDDED IN THE WOUND! :eek: I did a Tazzi "ohmygawdwhereisthec-spinewhenyouneedit" reaction, grabbed the first tech I saw to hold c-spine while I found a cervical collar and a place to get him supine.

Turns out that Einstein had been partying on a houseboat and decided to dive off the top of it! The only problem was that he dove into 3 FEET of water at a boat ramp! I stayed to watch the Dr. eval the pt. He turned out to have a fx of C3 w/no cord impingement. He hit the boat ramp so hard thatthere were small stones embedded under his scalp about 3 inches behind the wound. When I finally left, the ERP was still picking stones out of the wound w/forceps!