SMR and Birth

[Inspir]

A question that came up recently was how to perform SMR on a patient with a high index of suspicion of spinal and femur injury on a patient with an immediately impending child birth at the scene at a MVC. Which are your priorities? How can you modify SMR in this situation?

[dentedhead]

A question that came up recently was how to perform SMR on a patient with a high index of suspicion of spinal and femur injury on a patient with an immediately impending child birth at the scene at a MVC. Which are your priorities? How can you modify SMR in this situation?

If you tell me what SMR is, I may be able to attempt an answer for that scenario.

I have never seen or heard that short form used.

Dentedhead

[Inspir]

spinal motion restriction

[firedorval]

Well this is my thought.

On a scene of an MVC, on of the first thing to do on your assessment is ruling in or out C-spine precaution. The fact that your patient is pregnant or on the merge of delivering should affect your decision making. In the event that your patient has any kind of cervical vertebrea damaged (even tho chances a very low and it has been proven that EMS provider tend to over use spinal precaution), a slight movement can severe the spinal cord and paralize or stop your patient's breathing. Now this would be bad for both the mom and the baby...haha

So here is what I think: Do your spinal precaution as good as you can, c-collar, board and straps, and even tho it is uncomfortable, deal with the delivery after.

There is also a bunch of smoth muscle relaxant you can give you patient to slow down the delivery. Oh yeah..and don't forget to drive fast !!!!

[dentedhead]

Well this is my thought.


There is also a bunch of smoth muscle relaxant you can give you patient to slow down the delivery. Oh yeah..and don't forget to drive fast !!!!

Not sure what standing orders you work under,I would never give any type of narcotic or CNS depressant to a pregnant pt w/o a patch to BH. Even then I would be very leary of giving it.If a doc wants to give it they can wait til transfer of care.

Dentedhead

[dentedhead]

spinal motion restriction

Fair 'nuff never heard that before.

As always the pt will dictate the Tx.Are they conc uncoc?If so its ABC with a twist ACBC the other C= cervical.For easy reference we will presume no prev LOC, GCS 15 breathing okay and c/o mild pain @ C-6-7 and also @ L1-5,pt also c/o moderate abdo pain with obvious seatbelt abrasions.

BLS Tx collar extricate, board and strap being cautious around abdomen.Pillow or wedge under knees for comfort if pt condition allows,O2 via NRB @ 12lmin more prophalactically than anything.Constant monitoring of any increasing abdo pain,vaginal bleeding or noticiablefluid discharge dontt worry the pt will be more than vocal about alll of these..Other options are the KED with the front panel folded back and careful strapping.

If a femur is involved obviously most traction splints are ruled out.So revert to old school f/a.Splint with a pillow,board triangular and const monitoring of distal pulses and very importantly BP and pulse BP hypotension-possible bleed due to the fractured femur and more imporatntly placental tearing hypertension possible eclampsia/head injury.Monitor for shock anytime a femur or pelvis are involed the blood loss is surprisingly significant.

If the patient is actively labouring then the Tx is pretty much the same except the GRT of emergency chidbirth fall into play.

Dont let the severity of an MVC cloud your judgement,I have done some with minor damage and the baby has died in utero and I have done accidents involving fatalities and mom goes on to deliver a healthy and happy full term baby.

Dentedhead

[firedorval]

Not sure what standing orders you work under,I would never give any type of narcotic or CNS depressant to a pregnant pt w/o a patch to BH. Even then I would be very leary of giving it.If a doc wants to give it they can wait til transfer of care.

Dentedhead

I wasn't talking about pain control, narcotic or cns depresant, I was talking about a smooth muscle relaxant such as ventolin which could slow down labour.

[dentedhead]

I wasn't talking about pain control, narcotic or cns depresant, I was talking about a smooth muscle relaxant such as ventolin which could slow down labour.

That is providing you have enough ventolin(large dose required.) on board and IV capabilities otherwise it is not much help.It is not clinically proven to work in alll patients.

I apologize for not including ventolin as SMR,I just dont think of it having many uses in the prehospital setting other than its primary use.

Dentedhead

[Inspir]

Here’s another question that I can’t get my head around. A person with an obvious fracture to the pelvis with tenderness, instability, and crepitating would more than likely not be rolled onto a backboard as you would aggravate the injury further. More than likely use a scoop stretcher instead. My question is how do you asses the patients posterior if you cannot roll them to there sides? Would you just assess through the holes at the bottom of the scoop stretcher when they are off of the ground?

[Kearley]

First off, Yes to the scoop question. Adopt and do the best you can, our job is just life safety and packaging when it comes down to it. Remember why it is that we search for injuries; to take them into consideration when packaging.

Second. You make my laugh Dent. But I think we should all take from that rant that we should never just toss acronyms around. SMR could mean a bunch of things. But tell me Dent, are you compensating for anything?

[dentedhead]

First off, Yes to the scoop question. Adopt and do the best you can, our job is just life safety and packaging when it comes down to it. Remember why it is that we search for injuries; to take them into consideration when packaging.

Second. You make my laugh Dent. But I think we should all take from that rant that we should never just toss acronyms around. SMR could mean a bunch of things. But tell me Dent, are you compensating for anything?

Firstly you can to check for bleed,gross deformity,tenderness and crepitation by palpation of the pt while supine or the as found position.There are more than one way to board a pt.The scoop is a good idea.

Secondly WTF is your damage Kearley? I used all accepted and proper medical shorthand I would have used more except I dont know how to make them on a keyboard so FO x 2 HBD x24 and NFA cause you know SFA!!


Gotcha...... hows things working for uncle Stephan?Are you in the FF trade?

Dentedhead

[Ladymedic]

!
f you tell me what SMR is, I may be able to attempt an answer for that scenario.

Dentedhead

Gee dh, you know when this happens it's a key indicator that we're getting old and need to be put out to pasture. In our day it was just good ol "immobilization":o

[dentedhead]

Gee dh, you know when this happens it's a key indicator that we're getting old and need to be put out to pasture. In our day it was just good ol "immobilization":o

Thats why I sit backwards and dont think for myself now,it all went downhill with TLC..... the group not the medical short form:hmpf::motz::hmmmm2: