Saturday, July 23 2005

Slow to post, because there really has been nothing “on topic”. Didn’t turn a wheel last two duty nights – not once.

On the transport side, there was a cautionary tale – as usual, some of the details have been changed to protect patient identity.

If you’ve ever been involved in even a minor fender-bender, you may have had to wear a cervical collar (or “c-collar”). This is an extremely uncomfortable device which wraps around your neck, below the chin, and rests on your shoulders. It keeps your neck from flexing.

Mechanically, your cervical spine is a segmented broomstick with an eight-pound bowling ball balanced on it. If you don’t have full muscular control of your neck, or have even slightly damaged the bony structures therein, severe injuries may result to the encased spinal cord. The c-collar prevents that bowling ball of a head from crunching the neck bones. Usually the collar is precautionary, and the hospital can X-ray or CAT scan you and remove it shortly after your arrival. Sometimes they leave it on, and so should you.

A young man, unrestrained (read, “no seat belt”) driver in an MVA was boarded and collared by EMTs and rushed to the hospital. The patient had stopped breathing and a tube was inserted. Died on the table but was successfully resuscitated.

ABGs came back – his BAL was somewhere near the 500 mark (read as 0.50, way the hell up there).

Some unspecified time later, the patient regained consciousness and was extremely combative. The details are fuzzy, but the patient did bite through the pilot balloon of his ET tube (deflating the cuff), and ripped off his C-collar. He was chemically sedated and a new breathing tube inserted and a new collar placed.

Later still, the patient again “came to” and again angrily removed his uncomfortable C-collar.

Presto-Chango! Like a magician whipping away a handkerchief to show the rabbit has disappeared, the patient whipped his collar off, and all motor function from the chest down magically vanished. He has only gross motor skills in his arms, no finger movement.

Whoops. A couple of fractures at C6 and C7 which, over time, would have healed. The patient can wave his arms in the air, somewhat. There is no control below that point.

“But DTs,” you ask between sobs at this tragic tale, “How can this poor unfortunate breathe?” Ah! The magic of enervation and some well placed nerves. Google “myotome” for the details. And for gossakes leave the collar on until the doc removes it.


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