Nurses Clearing spine

dr clears cspine in our ed .

Mds clear c-spine in our ED, and I think that's the way it should be. Too much room for error that could result in major complications. Even if we were allowed to do so in our ED, I wouldn't put my license against that.

in terms of 'clearing' spines

define the situation ? are we talking aobut removing immobilisation applied by pre hospital providers or deciding whether to immobilise self presenters?

from the Uk perspective, only some of the NPs will remove immobilisation already applied, but most ofthe NPS and the more experienced initial assesment trained nurses will use the canadian c -spine rules to decide whether or not to immobilise self presenters

question for all those saying doctors only - what happens with self presenters? do they get immobilised and face the iatrogenic problems of being boarded only to be log rolled bum poked and let out of it all again a few minutes later?

I'll immobilize a patient who self-presents if patient c/o back pain or neck pain over bony prominences, or if it was a pretty good-sized wreck (better safe than sorry: I probably immobilize more than what needs it). I don't fully immobilize them (backboard, spider straps), I put a c-collar on and lay them flat on a stretcher. The backboard is good for transport, but otherwise doesn't serve much of a purpose on your cooperative patient.

MD's clear c-spine in my facility as well, as they should.

MDs ONLY! That's something I'd never do, ever! For those who present by private vehicle, we put on a C-collar, no back board.

canadian c-spine rules?

do tell

canadian c-spine rules?

do tell

http://www.aafp.org/afp/20040615/tips/17.html

in terms of 'clearing' spines

define the situation ? are we talking aobut removing immobilisation applied by pre hospital providers or deciding whether to immobilise self presenters?

from the Uk perspective, only some of the NPs will remove immobilisation already applied, but most ofthe NPS and the more experienced initial assesment trained nurses will use the canadian c -spine rules to decide whether or not to immobilise self presenters

"Clearing" c-spines refers to diagnosing that the pt. does not have a c-spine injury and therefore does not need immobilization. In other words, pts. who come in immobilized (via EMS) stay flat w/c-collar on until doc clears them, either by exam or after x-rays/other imaging studies.

As others have said, pts. who present to the ER by themselves and report an MVA, fall or other trauma w/the potential for a c-spine injury will get a collar and be laid flat on a stretcher until cleared by an MD.

Oh, and this must be an attending MD at my facility, not a resident.

eric - thanks for posting that link

still amazes me that you will imomobilise any and every patient who presents with neck pain and then keep them immobilised until reviewed by a senior doctor... yet we keep beign told how poor and backwards UK practice is...

probably have you in apoplexy to learn that UK ambulance staff are using the candian c spine rule at scene ( but Uk paramedics are at least considered proper health professionals none ofthe this working on the medicla directors licence stuff)

probably also have you in apoplexy to say we turn people round from triage to primary care or send them to gynae or mentla health without physician eview under agreed guideleins

still amazes me that you will imomobilise any and every patient who presents with neck pain and then keep them immobilised until reviewed by a senior doctor... yet we keep beign told how poor and backwards UK practice is...

probably have you in apoplexy to learn that UK ambulance staff are using the candian c spine rule at scene ( but Uk paramedics are at least considered proper health professionals none ofthe this working on the medicla directors licence stuff)

probably also have you in apoplexy to say we turn people round from triage to primary care or send them to gynae or mentla health without physician eview under agreed guideleins

Not any & every patient w/neck pain ... just those whose story includes some mechanism of injury that makes a collar a good precaution. That would be, you guessed it, remarkably similar to the Canadian c-spine rules you mentioned.

And no I'm not apopleptic that you have the option of directing people from A&E triage to a primary care or gyne setting ... just envious, thanks.

Have a good day.