脊椎評価の妥当性

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野外での脊椎損傷の疑いを除去するプロトコルとして、次の５つが一般的である；1)Canadian C-spine Rule (CCR)、2)the National Emergency X-Radiography Utilization Study (NEXUS)基準、3)修正版NEXUS基準, 4)メーン州基準(NEXUS基準に基づく)、5)the Wilderness Medical Society (WMS) アルゴリズム(CCRとNEXUSの統合)。

CCR

CCR

NEXUS

NEXUS

WMS

WMS

CCRは、MOIを注意深く観察することにより、頚椎損傷の疑いの除去に重きを置いている。NEXUS、修正版NEXUS、メーン州基準、WMSは、脊椎損傷を前提とし、S/SXによりその疑いを除去することに重点を置いている。NEXUSと修正版NEXUSの違いは、NEXUSが頚椎に重点を置いているのに対し、修正版NEXUSは、脊椎全体を問題としている。NEXUSは、脊椎の痛みの評価を含んでいないが、修正版NEXUSは、NEXUSもより慎重な評価となっており、メーン州基準は脊椎両側の圧痛も含んでいる。WMSは、CCRと修正版NEXUSを融合している。WMTCの脊椎評価は、これらの全てのプロトコルを含んでいる。
・脊椎評価を用いるかどうかに関わらず、まず傷病者評価テストの全体評価、一次評価、二次評価を終了させる。脊椎評価を行う場合は、傷病者の意識があり、協力的で、通常の痛み反応があり、脊椎に集中できない痛みがない信頼できる状態である。
・信頼性のない傷病者は、脊椎損傷を前提とし、より詳しい診断を受けるためにできる限り早く避難する。
・脊椎評価に合格した傷病者は、脊椎の問題のために、避難する必要はない。
・脊椎評価に不合格の傷病者は、脊椎損傷の疑いがあり、6-24時間以内に医師の診断を受けるために、避難すべきである。感覚、運動テストに不合格した傷病者は、脊髄損傷の疑いもある。
・脊椎評価の結果はSOAPノートに記述すること。
・WMTCの脊椎評価はデジタルハンドブックを参照する。
・SOAPノート、デジタルハンドブックの正確な活用にはWMTCのWFA/WFRが必要である。

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