Version: 3.0 010908 Learning Outcomes Hold a basic understanding of spinal cord anatomy and injuries Describe the possible causes of spinal injuries Detail the signs and symptoms of a patient with suspected spinal injuries Detail the principles of immobilisation for spinal injuries Detail and demonstrate the management of head and spinal injuries Demonstrate how to move a casualty with suspected spinal injuries
Version: 3.0 010908 Introduction This non-accredited course is designed to link existing knowledge with more detailed information so best practice spinal management techniques are achieved in your workplace The information given: Focuses on principles of good spinal care in an emergency situation Provides a range of management options Enables the learner to develop individual management plan specific to each incident Allows for organisational practices to be included Draws on trained and untrained rescuers
Version: 3.0 010908 Spinal cord injury SLSA recorded 158 suspected spinal injuries between August 2006 and July 2007. Each year 50 people are injured in diving accidents in Australia. Average cost to support a person who has sustained a major spinal injury is over $1,250,000 per person.
Version: 3.0 010908 SPINAL CORD INJURY SCI Classifications Traumatic – resulting from an external causes Non-traumatic – caused by medical conditions
Version: 3.0 010908 SCI Treatment Centres Australia has 6 hospitals that care for SCI patients. They are located in the following 5 states. QLD – Princess Alexandra Hospital NSW – Royal North Shore Hospital & St James Hospital VIC – Austin Hospital SA – Royal Adelaide Hospital WA – Royal Perth Rehabilitation Hospital Tasmania, NT and the ACT do not have Spinal Units, patients are sent to the nearest interstate Spinal Unit.
Version: 3.0 010908 Spine & Nervous System Spine 42 cm long 33 vertebrae Allows movement, twisting and bending of the spine Natural ‘S’ curve
Version: 3.0 010908 Spinal column Vertebrae –Protects spinal cord –Provides support to the body –Outer section bony mass offers point of attachment –Inner hollow provides a passageway for spinal cord to run through Cerebrospinal fluid (CSF) acts as cushion against injury 31 spinal nerves running from spinal column communicate with whole body
Version: 3.0 010908 Nervous system Divides into two parts Central Nervous System (CNS) –Dorsal cavity –Cranial subcavity –Spinal cavity Peripheral Nervous System (PNS) –Somatic nervous system –Sympathetic nervous system –Parasympathetic nervous system
Version: 3.0 010908 Mechanisms of injury MOI is the exchange of forces that results in an injury.
Version: 3.0 010908 5 Mechanisms of SCI Hyperextension –Spine arched backwards beyond normal limits –Type of injury most commonly in the upper cervical section of spinal cord –Common causes are motor vehicle accidents and shallow water diving accidents
Version: 3.0 010908 5 Mechanisms of SCI Hyperflexion –Spine arched forwards beyond normal limits –Type of injury most commonly in the upper cervical section of spinal cord –Common causes are whiplash or falling down stairs.
Version: 3.0 010908 5 Mechanisms of SCI Compression –Spinal cord is compressed –Commonly results in injuries to C5-6 and T12-L1 –Common causes diving injuries and impacting windscreens in motor vehicle accidents
Version: 3.0 010908 5 Mechanisms of SCI Distraction –Overstretching of the spinal cord –Caused by hanging injuries or playground injuries to children
Version: 3.0 010908 5 Mechanisms of SCI Rotation –Head and body rotate in opposite directions –Common causes are motor vehicle accidents and if ejected from the vehicle
Version: 3.0 010908 Common causes of SCI motor vehicle accident industrial accident (workplace) diving accident sporting accident a fall from a height a significant blow to the head severe penetrating wounds (i.e. gunshot) SLSA/ALA v1.0 Apr 2008
Version: 3.0 010908 SCI Types of injury Tetraplegia or (Quadriplegia): –‘Paralysis of four limbs’ –Impairment or loss of motor or sensory function in the cervical segments of the spinal cord. –At this level, arms and legs are affected Paraplegia: –Paralysis of both lower extremities –Impairment or loss of motor or sensory function in the thoracic, lumbar or sacral segments of the spinal cord. –At this level, the SCI patient will still have arm function
Version: 3.0 010908 Signs & symptoms Signs Breathing difficulties* Loss of consciousness or fading in & out* Loss of function in hands, fingers, feet or toes* Loss of bladder or bowel control* Neck or head in abnormal position* Dilated pupils Fluid leaking from the ears Abnormal blood pressure Profuse bleeding from the head Abrasions or bruising to the head or forehead Shock Symptoms Back or neck pain (intense*) Tingling or lack of feeling in lower or upper limbs Increased muscle tone Headache or dizziness
Version: 3.0 010908 Secondary injury First responders prevent further injury through the application of sound incident management practices; i.e. Preventing further movement Oxygen therapy Correctly preparing patient for transportation Accurately record the patient’s vital signs, incident details and provide first aid Treat patient for shock
Version: 3.0 010908 How to classify SCI? Complete Injuries: Complete SCI are total loss of motor function (paralysis) and sensory perception is a result of interruption of the ascending and descending nerve tracts in the spinal cord. Incomplete Injuries: There is some function below the level of SCI 67% of SCI in Australia are incomplete Poor management of the patient with incomplete SCI can cause progressive worsening of spinal cord function
Version: 3.0 010908 Special considerations Padding under child or infant’s torso Biker’s torso will assist in aligning patient’s head to the neutral position
Version: 3.0 010908 Primary survey – SCI patient D – Danger R – Response A – Airway management and cervical spine stabilization B – Breathing (ventilation) C – Circulation and bleeding D – Defibrillation
Version: 3.0 010908 Check for contraindications Conscious patient Patient’s head or part of their torso is tilted and the patient is unable to move from that position Moving the patient’s head or spine can not be performed because of space limitations or other conditions. Airway obstruction Breathing Difficulties Unconscious patient Not Breathing Moving the patient’s head or spine can not be performed because of space limitations or other conditions. Airway obstructions Where a contraindication becomes evidence STOP the course of action immediately and immobilise the patient as is.
Version: 3.0 010908 Remove motorcycle helmet? Reasons that it may be necessary to take off a casualty’s helmet at the scene of the accident include: to obtain a clear airway (conscious or unconscious patient) for oxygen therapy to be administered to apply a cervical collar to place the patient’s head into a neutral position, as the helmet has lifted the head into hyperflexion.
Version: 3.0 010908 Learning task one Complete learning task one on page 28.
Version: 3.0 010908 Types of spinal immobilisation & retrieval equipment Step 1 minimise further movement of patient’s head by using - –manual stabilisation – standing or supine –vice grip. Step 2 Fit cervical collar Step 3 Utilise lifting and carrying devices
Version: 3.0 010908 Types of spinal immobilisation & retrieval equipment See Learners Manual pages 29 to 38.
Version: 3.0 010908 Learning task two Complete learning task two on page 35.
Version: 3.0 010908 Cervical collar Applied by trained and experienced personnel only Check manufacturer’s fitting instructions Ideally two people to fit collar –Rescuer one performing manual stabilisation –Rescuer two fits collar Communicating your actions with the conscious patient is critical. Manual stabilisation must continue after the fitting of the cervical collar.
Version: 3.0 010908 Cervical collar - supine patient The same steps apply as for a standing or seated patient. Except, fold in Velcro fasteners to protect from contamination by sand or gravel.
Version: 3.0 010908 Learning task three Complete learning task three on page 39.
Version: 3.0 010908 Safe transportation of a patient Australian Resuscitation Council advise that an injured or unconscious patient’s condition can be worsened by movement. If movement is necessary of a conscious patient, extreme care must be taken to minimise movement of the spine in any direction, and the painful area must be fully supported. Airway management takes precedence over any suspected spinal injury in an unconscious patient Guideline 8.18 www.resus.org.auwww.resus.org.au
Version: 3.0 010908 Log roll Cervical collar fitted first Accepted method to position a patient on their side Allows for placement of blanket, board or litter against spine Positions patient’s arms down either side of torso Supports thoracic/lumbar area against sagging
Version: 3.0 010908 Backboard sitting patient Cervical collar fitted first Allows for minimal movement to patient’s spinal column Minimum 3 people to perform this technique Back board lowered to ground Patient is slid along board in 30 cm increments to correct position
Version: 3.0 010908 Aquatic rescue (pool or still water) Rescuer to move cautiously towards patient Minimise water movement around patient Stabilise patient’s head using either Vice grip technique Extended arm roll-over technique (surf retrieval) Fit cervical collar
Version: 3.0 010908 Trapezius grip The trapezius grip is used to support the patient’s head and neck, whilst allowing the fitting of a cervical collar. Grip upper trapezius muscle between thumb and the fingers, supporting the head between the forearms (held vice-like along side of head) To allow for the cervical collar to be fitted, the rescuer grips the trapezius muscle between the extended middle and ring fingers (forming a V-shape). The forearms continue to provide firm support to the head See Learners Manual p.65
Version: 3.0 010908 Learning task four Complete learning task four on page 69 to 71.
Version: 3.0 010908 Preparing patient for transport Immobilisation strapping is fitted before moving the patient from the water. Chest strap is secured first, followed by hip or feet (see manufacturer’s guidelines) and finally the head strap is applied. Manual stabilisation continues at all times until handover Reassure the conscious patient continually Monitor patient’s body temperature (shock to nervous system affects ability to self-regulate) Protect patient from elements; sun to eyes, wind on body, etc.
Preparing patient for transport Key considerations when moving the patient on a spinal board. Always move patient in head first direction Avoid lifting one end of the board higher than the other – keep horizontal, or head higher on stairs Do not slide spine board across the ground or surface, it may catch and jerk or jolt the patient Ensure hair, jewellery and clothing is clear and can not catch against surfaces or become caught in the rescuers hands, straps, etc.
Version: 3.0 010908 OHS considerations Observe OHS recommendations when lifting patient from ground level use a minimum of 4 people to lift.
Version: 3.0 010908 Learning task five Complete learning task five on page 56.
Version: 3.0 010908 Practical demonstration Now move to the pool or a still water environment to practice your spinal management techniques.
Version: 3.0 010908 Assessment Assessment is complete when you have: Demonstrated spinal management and patient removal techniques in an still-water aquatic environment Answered the questions and handed-in the Learner Assessment Activity to your assessor for marking.