Wilderness and Rescue Medicine 7th Edition Jeffrey Isaac, PA-C and David E. Johnson, MD

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Section IV: Trauma

The decision to defer spine stabilization in a high-risk injury to reduce some other risk may not be an easy one to make. The thought of a res- cuer being responsible for permanent spinal cord damage is appropriately frightening. However, the risk is minimal compared to the often-substantial dangers in wilderness and technical rescue, and to the morbidity and mortality associated with aspiration, hypothermia, and delayed treatment of critical system problems. If you choose to defer ideal protection, the reasons should appear in your problem list. You might note that problem 1 is a spine that cannot be cleared. Problem 2 might be the fact that the temperature is 20° below zero with 30 knots of wind, and you and your patient are going to freeze to death if you stay where you are.

Spine Injury Summary

General Principles

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WILDERNESS PROTOCOL

Clear • Reliable patient • No spine pain, tenderness, neurological deficit Low Risk • Reliable patient • Tolerable pain and tenderness; moves easily • No neurological deficit High Risk • Persistent neurologic deficit (emergent evac) • Severe pain or tenderness; cannot or will not move • Unreliable patient with significant MOI

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