When a patient falls...

[medicrnohio, RN]

Here's the story. We had a patient fall on my unit last night. Patient put on bathroom call light and 30 seconds later we heard a very loud noise coming from the room. Walked into room to find patient laying on the floor unresponsive with snoring and very slow respirations. Someone called a code. They were screaming "He doesn't have a pulse." The patient had a normal radial pulse. I grabbed the ambu bag and was going to use it when patient became responsive. He picked his head up off the floor and blood just started pouring out. The resident ordered a CT scan and a trauma consult. The patient had to have hit his head on the counter before hitting it on the floor. Everyone is sitting around trying to figure out what to do next. I suggested a backboard and c-collar. They agreed with that after hestitating for a few moments. Apparently they didn't seem to think it was necessary. I was out of the room when the c-collar was placed on the patient. They asked me to come back in when it was time to get patient on backboard. As we were getting ready to move patient onto backboard I asked if someone was going to maintain c-spine. I was told "We don't need to, he has the c-collar on." I was a medic for 4 years before becoming a nurse and I know better than that. After getting patient onto board and onto the stretcher, they wanted to take patient off the backboard.

So tell me, was I wrong to suggest that c-spine be maintained? What would you have done? Does your hospital have a protocol for this type of incident? Have you been trained on how to handle a patient with a possible head or neck fracture?

This whole incident bothers me sooooo much. Many times I feel like the nurses I work with really put their patients in danger. They could have worsened any head or neck fractures with their incompetent (in my opinion) behavior and actions.

Sorry this was so long. Looking forward to your replies.

[mommatrauma, RN]

You are absolutely right...The collar does nothing at all to maintain cspine precautions...it does not stabalize the neck, it helps immobilize it to help remind the patient not to move around...Someone must still at all times while moving patient maintain cspine immobilization by holding the neck...We have a protocol w/in our trauma department...Even when they think it is low risk we still maintain it...If they were worried enough to put the collar on...you have to go full on press with precautions...not stop halfway through...taking the backboard off is okay. We actually try to do this asap, simply because its uncomfortable and tends to make the patient move around more because of that. It is actually part of the national registry test for both PH-RNs and medics that simply a collar in place does not maintain proper immobilization in and of itself...

[CoffeeRTC, BSN, RN]

I do that even in LTC. Yep I'm looked at funny and even debated, but until the medics get their, I do all the precautions for any suspect fall.