OVERVIEW

 Spinal anatomy and physiology

 Review spinal injuries
 Patient assessment
 Spinal injury management
 Special problems in spinal injuries
ANATOMY OF THE
SPINE AND SPINAL CORD
ANATOMY OF VERTEBRA
Spinal Transverse
Cord Process Spinous
Process

Body
KINEMATICS OF BLUNT SPINAL
INJURY
 Hyperextension
 Hyperflexion
 Compression
 Rotation
 Lateral Stress
 Distraction
SPINAL CORD INJURY
 Primary cord injury
 Damage is immediate and irreversible
 Cord is cut, torn, crushed, or loses blood supply
 Secondary cord injury
 Cord injury develops later from:
 Hypoxia, swelling, hypotension, compression from bleeding or
swelling around the cord
 Good patient care will limit secondary injury
SIGNS AND SYMPTOMS
OF SPINAL INJURY

 Pain
 Local muscle spasm
 Paralysis
 Sensory dysfunction
NEUROGENIC SHOCK
 Catecholamines are released by the adrenal
glands
 Catecholamines regulate BP by heart rate and
vasoconstriction
 Loss of nerve signals to the adrenals causes
neurogenic shock
 Low BP, normal or low heart rate, warm, dry, pink
skin
EVALUATION OF POSSIBLE SPINAL INJURY
 Ask patients to move hands and feet before
and after extrication
 Scene Survey
 Note clues to spinal injury from mechanism of
injury
EVALUATION OF POSSIBLE SPINAL INJURY
 BTLS Primary Survey
 Note clues to spinal injury from patient’s complaints
 Note clues to spinal injury from Rapid Trauma Survey
 Unconscious patients are assumed to have spinal injury
SPINAL EVALUATION DETAILED EXAM
 Conscious patients
 Sensory — touch fingers & toes
 Motor — have patient move fingers & toes
 Unconscious patients
 May withdraw or localize when you pinch
fingers and toes
 Document and repeat every 5 min.
 When in When in
doubt doubt
immobilize immobilize
AIRWAY CONTROL AND SPINAL IMMOBILIZATION
 Stabilize in neutral position
 Open & secure airway if necessary
 Apply c-collar
 Do not release spine until fully immobilized in
appropriate devices
 Delegate someone to be responsible for airway
 If intubation is needed: manual in-line
stabilization during procedure
UNCONSCIOUS TRAUMA
PATIENTS HAVE 15-20%
INCIDENCE OF SPINAL INJURY
TREATMENT OF NEUROGENIC SHOCK
 100% oxygen
 Complete spinal immobilization
 Delegate someone to be responsible for the airway
 Load & Go
 IV fluids to maintain BP of 90-100 mmHg systolic
(with head injury maintain 110-120mmHg systolic)
 SPECIAL SITUATIONS
 Closed space rescue
 Water rescue
 Prone & standing
patients
 Pediatric patients
 Geriatric patients
 Obese patients
 SPECIAL SITUATIONS
 Patients in protective
helmets
 Patients with neck
wounds
 Patients in immediate
danger
 Rapid extrication
 Confused, combative
patients
HELMETS
 Patients with helmets & shoulder pads
 Leave helmet in place but remove face mask to access
the airway
 Motorcycle helmets
 Will usually cause flexion of the neck
 Must remove full face helmets to manage the airway
 Remove before placing patient on backboard
SUMMARY
 Scene Survey for clues to spinal injury
 Hand-immobilize spine
 BTLS Primary Survey
 ABCs
 History for clues to spinal injury
 Check back
 Spinal immobilization indicated?
 Transport decision
 Critical interventions
QUESTIONS?