Prehospital Trauma Life Support

Lesson

9
Copyright © 2003, Elsevier Science (USA). All rights reserved.

Spinal Trauma

PROVIDER COURSE

Objectives
• Identify life-threatening conditions associated with spinal trauma • Recognize the indications for spinal immobilization • Discuss the principles of spinal immobilization • Describe use of rapid extrication

9-2
Copyright © 2003, Elsevier Science (USA). All rights reserved.

Spinal Trauma
• Significant kinetic energy can produce injury to the spine and/or spinal cord • Potential for these injuries must be recognized • Failure in assessment and management can result in permanent paralysis • Spinal injuries have a substantial lifelong financial impact on the victim

9-3
Copyright © 2003, Elsevier Science (USA). All rights reserved.

. Elsevier Science (USA). All rights reserved.000 spinal injuries occur annually • The most common age is 16 to 35 years old • Causes: – – – – MVCs Falls Penetrating injuries Sports injuries 9-4 Copyright © 2003.000 to 20.Spinal Trauma • As many as 15.

Elsevier Science (USA).Anatomy Spinous process Vertebral foramen Body 9-5 Copyright © 2003. . All rights reserved.

All rights reserved. Elsevier Science (USA). .Anatomy • • • • • Cervical (7) Thoracic (12) Lumbar (5) Sacrum (5) Coccyx (4) 9-6 Copyright © 2003.

paresthesia (numbness).Pathophysiology • The spinal cord contains the motor and sensory nerve tracts • Damage may result in: – Weakness or paralysis – Pain. . Elsevier Science (USA). All rights reserved. or total loss of sensation 9-7 Copyright © 2003.

9-8 Copyright © 2003. . Elsevier Science (USA).You are called to a public pool for a 16-year-old male who sustained an injury while diving. Upon your arrival he has been removed from the pool. All rights reserved.

loss of motor and sensory function in extremities E .Slow heart rate.No other obvious injuries What is the life-threatening problem? 9-9 Copyright © 2003. warm extremities D . All rights reserved.Patent B .Rapid and shallow C . Elsevier Science (USA). .GCS score 15. weak radial pulse.Primary Survey A .

Sensory Assessment Nipple line = T4 Umbilical line = T10 9-10 Copyright © 2003. All rights reserved. . Elsevier Science (USA).

loss of intercostal muscles 9-11 Copyright © 2003. Elsevier Science (USA). All rights reserved. .diaphragm still functions.Ventilatory Impairment • High cervical injuries .loss of total ability to breathe • Lower cervical injuries .

All rights reserved. . Elsevier Science (USA).Neurogenic Shock • Hypotension associated with cervical or high thoracic spinal cord injury • Disruption of sympathetic nervous system – Vasodilation below injury – Heart—bradycardia Failing to consider hypovolemia as a cause of shock 9-12 Copyright © 2003.

How would you manage this patient? 9-13 Copyright © 2003. All rights reserved. . Elsevier Science (USA).

. All rights reserved. 9-14 Copyright © 2003. Elsevier Science (USA).A 28-year-old male has been shot in the neck by his girlfriend.

Patent B . radial pulse fast and weak D . BS equal C . Elsevier Science (USA).Primary Survey A . All rights reserved.Fast.GCS score 15. .Expanding hematoma to left side of neck When is spinal immobilization indicated for penetrating trauma? 9-15 Copyright © 2003. no neurologic deficits in extremities E .Copious external hemorrhage from neck wound.

Elsevier Science (USA). All rights reserved.Penetrating trauma Neurological deficit/complaint? Yes IMMOBILIZE Rapid transport No IMMOBILIZATION NOT INDICATED Rapid transport • Unstable spinal fractures from penetrating trauma are extremely rare • Life-threatening conditions take priority Copyright © 2003. 9-16 .

You are called to a nightclub where a 35-year-old female has fallen down a flight of stairs. All rights reserved. . Elsevier Science (USA). Your patient denies neck and back pain but complains of severe left ankle pain. You smell alcohol on her breath. 9-17 Copyright © 2003.

BS clear C .Normal.Minor bleeding from small scalp laceration. normal radial pulse D .Patent B .Grossly deformed left ankle When is spinal immobilization indicated for blunt trauma? 9-18 Copyright © 2003. All rights reserved.Primary Survey A .Slurred speech. Elsevier Science (USA). GCS score 15 E . .

.Blunt trauma Altered level of consciousness (GCS. All rights reserved. Elsevier Science (USA).15) Yes No IMMOBILIZE Rapid transport Spinal pain or tenderness? or Neurologic deficit or complaint? or Anatomic deformity of spine? Yes No IMMOBILIZE Rapid transport Concerning mechanism of injury? 9-19 Copyright © 2003.

Elsevier Science (USA).Concerning Mechanism of Injury • Violent impact to the head. . deceleration. torso. or lateral bending forces to neck or torso • Any fall • Ejection or fall from any motorized or humanpowered transport device • Shallow-water diving incident 9-20 Copyright © 2003. neck. or pelvis • Sudden acceleration. All rights reserved.

All rights reserved. or crush injury Large burns Any other injury that produces acute functional impairment 9-21 Copyright © 2003. degloving.Distracting Injuries • Any injury that may have the potential to impair the patient’s ability to appreciate other injuries – – – – – Long bone fracture Suspected visceral injury Large laceration. Elsevier Science (USA). .

. All rights reserved. Elsevier Science (USA).Inability to Communicate • Speech or hearing impaired • Foreign language speaking • Small children 9-22 Copyright © 2003.

All rights reserved.Concerning Mechanism Of Injury Yes Presence of: Evidence of alcohol/drugs or Distracting injury or Inability to communicate No IMMOBILIZATION NOT INDICATED Transport Yes No IMMOBILIZE Rapid transport IMMOBILIZATION NOT INDICATED Transport When in doubt. . Elsevier Science (USA). immobilize! 9-23 Copyright © 2003.

All rights reserved. The vehicle has moderate damage. After your patient’s vehicle was rearended it was propelled into the vehicle in front of it.You are called to the scene of a multi-vehicle crash on a highway. On the basis of kinematics. . Elsevier Science (USA). why should spinal injury be suspected? 9-24 Copyright © 2003. The driver was unrestrained and the windshield is spider-webbed.

.Primary Survey A .Abrasion on forehead What are the indications for rapid extrication? 9-25 Copyright © 2003.Patent B .GCS score 15 E .Normal radial pulse D .Normal. BS clear C . Elsevier Science (USA). All rights reserved.

All rights reserved. . Elsevier Science (USA).Rapid Extrication Indications: • Threat to life identified in primary survey • External threat to patient or rescuers Using rapid extrication when not indicated Not using rapid extrication when indicated 9-26 Copyright © 2003.

What role does a cervical collar play in spinal immobilization? How is spinal immobilization performed? 9-27 Copyright © 2003. Elsevier Science (USA). All rights reserved.The patient is complaining of neck pain. .

Cervical Collar • Adjunct only: DOES NOT IMMOBILIZE! • Apply after returning head to neutral inline position unless contraindicated • Must be rigid and properly sized • Should not impair opening of mouth 9-28 Copyright © 2003. . All rights reserved. Elsevier Science (USA).

All rights reserved. Elsevier Science (USA). .Spinal Immobilization • • • • • • • • Manual stabilization in neutral inline position Assess neurologic function Apply cervical collar Secure torso Apply padding where needed Secure head Secure extremities Reassess primary survey/neurologic function 9-29 Copyright © 2003.

All rights reserved. Elsevier Science (USA). or the head before the torso Failing to immobilize the entire spine Failing to use interim device when indicated 9-30 Copyright © 2003. .Spinal Immobilization Over reliance on cervical collar Immobilizing only the head.

All rights reserved. • Perform rapid extrication when indicated. • Identify and treat life-threatening conditions first. . • When in doubt. Elsevier Science (USA). • Spinal immobilization must be complete.Summary • Kinematics and assessment are key to recognizing potential for spine/spinal cord injury. immobilize! 9-31 Copyright © 2003.

Please make a selection from the menu below. Elsevier Science (USA). All rights reserved.Prehospital Trauma Life Support Lesson Nine is complete. . Return to Main Menu Return to Provider Course Table of Contents Exit/Quit 9-32 Copyright © 2003.

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