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Cuando voy a inmovilizar columna?

Criterios del mecanismo de lesin 1. Alta energa involucrada. (ms de 60km/h) 2. Impacto con vehiculo mayor. 3. Vehiculo Volcado / Persona Eyectada. 4. Accidente de vehiculos motorizados recreacionales / Bicicletas. 5. Caida de ms de 1 metro de altura. 6. Carga axial al la columna (piqueros). 7. Cadaver en el lugar. Criterios del paciente 1. Dficit neurolgico. 2. Deformidad anatmica de la columna. 3. Dolor espontaneo o la palpacin de la columna. 4. Drogas / alcohol involucradas. 5. Dificultades de comunicacin (extrangeros, edades extremas). 6. Distractores (otras lesiones, psicolgicas). 7. Edades Extremas (menor de 5 o mayor de 65 aos).

Cuando voy a inmovilizar columna?


7 criterios del mecanismo 7 criterios del paciente 1 criterio de duda

15 criterios de inmovilizacin

Si ninguno de estos criterio aplica, entonces NO corresponde inmovilizar. Es mejor inmovilizar de ms que de menos, por lo tanto ante la duda, INMOVILIZAR (Criterio 15)

Fuentes
1. MANUAL PHTLS. American College of Surgeons. 2. Protocol Directed Torture: Unnecessary Spinal Immobilization Kelly Grayson, CCEMT-P 3. Coastal Valleys EMS Agency ALS SPINAL IMMOBILIZATION GUIDELINE ALWAYS USE UNIVERSAL PRECAUTIONS 4. COUNTY OF VENTURA HEALTH CARE AGENCY EMERGENCY MEDICAL SERVICES POLICIES AND PROCEDURES Policy Title: Spinal Immobilization

Protocol Directed Torture: Unnecessary Spinal Immobilization Kelly Grayson, CCEMT-P


Brown LH, Gough JE, Simonds WB. Can EMS Providers Adequately Assess Trauma Patients for Cervical Spine Injury? Prehospital Emergency Care, 1998 Jan-Mar; 2 (1):33-6. Burton JH, Dunn MG, Harmon NR. A Statewide Emergency Medical Services Spine Assessment Protocol: Review and Outcomes From 16,000 Trauma Encounters, Journal of Trauma, 2006 July;61 (1):161-7. Burton JH, Harmon NR, Dunn MG, Bradshaw JR. EMS Provider Findings and Interventions With a Statewide EMS SpineAssessment Protocol. Prehospital Emergency Care. 2005 JulSep;9(3):303-9. Dawodu S. Spinal Cord Injury: Definition, Epidemiology, Pathophysiology. www.emedicine.com Hoffman, JR. Validity of a Set of Clinical Criteria to Rule out injury to the Cervical Spine in patients With Blunt Trauma. New England Journal of Medicine, 2000; 343: 94-9.

Protocol Directed Torture: Unnecessary Spinal Immobilization Kelly Grayson, CCEMT-P


Morris CG, McCoy EP, Lavery GG. Spinal Immobilisation for Unconscious Patients With Multiple injuries. British Medical Journal, 2004; 329: 495-499. Hauswald M, Braude D. Spinal Immobilization in Trauma Patients: Is It Really Necessary? Current Opinions in Critical Care, 2002. Dec; 8 (6): 566-70. Stiell I, et al. The Canadian C-Spine Rule Versus the NEXUS Low-Risk Criteria in Patients With Trauma. New England Journal of Medicine 349: 25102518, Dec 2003. Stroh G, Braude D. Can an Out-of-Hospital Cervical Spine Clearance Protocol Identify all Patients With Injuries? An Argument for Selective Spinal Immobilization. Annals of Emergency Medicine, 2001. June; 37 (6): 609-15.

Coastal Valleys EMS Agency ALS SPINAL IMMOBILIZATION GUIDELINE ALWAYS USE UNIVERSAL PRECAUTIONS AUTHORITY Division 2.5, Health and Safety Code, Sections 1797.220 & 1797.221

ALS Treatment Guidelines July 2006 ALS Spinal Immobilization - 9003 Page 1 of 1

COUNTY OF VENTURA HEALTH CARE AGENCY EMERGENCY MEDICAL SERVICES POLICIES AND PROCEDURES Policy Title: Spinal Immobilization

PURPOSE: To define the use of spinal immobilization by field personnel in Ventura County. II. AUTHORITY: Health and Safety Code, Sections 1797.214, 1797.220, 1798, and 1798.200, CCR Division 9, Chapter 4, Sections 100175, 100179 II. POLICY: Field personnel in Ventura County may apply spinal immobilization devices under the following circumstances.