Selective immobilization in victims of trauma
Introduction
Is it necessary to restrict the movements to all patients victims of trauma? You once noticed in your daily practice that an immobilized patient complained about pain and discomfort. I know the answer will be yes. Well, clear immobilization in a rigid column table is not pleasant, being tied in a hard table like the floor of feet and hands does not make any comfortable, being placed on a rigid table is an uncomfortable extreme experience for the patient. A non -cossed table will cause manifestations of dorsal discomfort after a relatively short time.
Developing
The spine immobilization in a rigid column table took several years to position themselves as the treatment of choice for patients with a suspicion of spine lesion mechanism. And now the evidence gives us data that could indicate that this was not quite well. Imagine 10 years teaching pre-hospital care providers to immobilize all patients just to say no, that is not quite right.
When a patient suffers trauma in which several parts of his body among them the spine have been exposed to an exchange the movements should be limited to avoid the possible aggravation of medullary injuries. This trial will review the problems that represent the limitation of the movement of a patient in a rigid column table and the different recommendations of when to apply this procedure and when not
When a patient is a victim of a traumatic event such as the crash in a car, the fall of a horse, a shock on a motorcycle, his body experiences a strong energy exchange, result from which body’s tissues usually leave injured. The human body has an axis to which all structures are anchored, this axis is the spine, if some energy is transmitted to the insurance, the force will be transported by the spine. The vertebrae are aligned and together with each other forming a duct, inside this duct is the spinal cord which is the great communication path between the brain and the other parts of the body.
When there is an injury to the vertebrae there is the possibility that the spinal cord is also injured causing the patient lost of sensitivity and motor skills of the limbs or in some cases the death by respiratory unemployment depending on what height of the column the lesion happened. The most vulnerable spine zone to injure is the neck, since it does not have more muscles that protect it.
To avoid injuring or in certain cases the lesion of the spinal cord is worsened, the patient should be placed in dorsal position and limit the movements, the choice devices for this procedure are a rigid column table, head fasteners, a rigid collar and Aneses that ensure it to feet, however to determine that a patient has a high probability of spine lesion a thorough examination should be done.
The immobilization is fine, however, there is an excessive or abusive use of this procedure. Let’s imagine ourselves lying on the ground hard for more than 20 minutes. The discomfort of the immobilization procedure is largely due to the straight and flat shape of the device. Unfortunately, it does not yet reach the most comfortable operative emergency services for immobilization processes, such as vacuum mattress.
In practice, textbooks fall short, because innumerable conditions are presented to which literature did not prepare us. Immobilization cannot be the exception. When trying to immobilize a patient who has suffered trauma, several challenges are presented. One of them is the pain that the patient is experiencing. The right thing following a guide for pain management would be to allow the patient to be placed in the position that decreases the pain.
This would go against the immobilization procedure, because in this action we avoid the patient’s movements to the maximum. Many times in this position the patient complains of discomfort and pain, if additional pain he already felt.
When working in the city the hospital closest to the much will remain at a distance of 20 minutes in the ambulance, this is very beneficial for the patient victim of trauma and immobilized. But not all environments are so close to health houses. There are rural areas in which the closest care centers are 3 or 4 hours away ambulance or in the worst case in truck. In prolonged transport the handling of a traumatized patient with immobilization in a rigid column table present great controversy.
The skin tissues when exposed at pressure begin to stop receiving the correct amount of blood flow so that pressure and ischemic areas are generated. Bone support points begin to pain. The legs are cushioned and cramps can be produced. All this in approximately 40 minutes in a long table. A traumatized patient who is immobilized in a long table will not be able to remain in this more than 40 minutes.
To perform any treatment we must first diagnose the disease. Spine lesions happen in medium and high energy exchange accidents. The human being is equipped with muscle and fatty tissue that protect the organs. When an energy exchange occurs, they did not support these protections and the energy is transferred to the organs. This procedure usually gives signs and symptoms. The most obvious will be the pain. If the patient is injured the spine, the most logical thing is that he feels pain in this area.
There are times that larger injuries or that affect the patient’s psychology distract from a spine lesion. The use of alcohol or drugs can decrease the perception of pain, thus avoiding that the patient feels pain. When there has been a proven head trauma or the state of consciousness gives us an indication of that, that is, the Glasgow is altered. All this leads us to the need to immobilize
There are some considerations that guide us to know when the immobilization procedure is not necessary. If the patient does not present pain in the middle line of the back or neck and does not present any distracting lesion, this suggests that an injury to the spine is unlikely. In penetrating traumas where no indication is evidenced that leads us to suspect spinal injury, such as hemiplegia or hemiparesis. When there is no evidence that the patient has ingested alcoholic beverages or drugs. These types of patients will not benefit from the use of immobilization.
There are other immobilization options that, unlike the rigid column table, could be used in patients victims of trauma, but with comfort plus. If we do not have these devices or a long column table.
The importance of being clear about when using or not immobilization in the rigid table is that in clinical practice the patient should always be given and what is scientifically proven, the different types of immobilization serve us as long as Let’s keep the premise of preventing excessive movements of the body’s axis or the spine, without neglecting the patient’s comfort.
Conclusions
At present, two means are used by which the patient is immobilized; one the rigid column table that is a rigid plastic device about 2 meters in diameter that has the sides of the grip, and that is accompanied by harness -shaped holders, and another is the empty mattress that resembles To a deflated mat, which contains inside a hollow space full of soft material, on the sides it has clamping straps and in its upper part an attachment specially designed for the head, this device requires a manual pump that is used to remove all the air inside and that the device adapts to the patient’s body. In my opinion, the vacuum matt.
The immobilization in a rigid column table will only be carried out if indicated, otherwise its use should be avoided. Other ways to mobilize a patient are manual transport and wheel stretcher, which are very versatile when accessing any land, if the place is difficult to access we could perform the mobilization with the folding stretcher until to the stretcher with wheels.
There is a long way to go regarding the investigation of pre-hospital medicine, even more so that evidence-based medicine is what governs any action in the field with the patient, the problems that are observed day by day in the practice should be motivating for what their own data and research are generated that understand the reality in which we work.
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