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Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 9 Spinal Trauma.

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Presentation on theme: "Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 9 Spinal Trauma."— Presentation transcript:

1 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Chapter 9 Spinal Trauma

2 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Topics Introduction to Spinal Injuries Spinal Anatomy and Physiology Pathophysiology of Spinal Injury Assessment of the Spinal Injury Patient Management of the Spinal Injury Patient

3 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Introduction to Spinal Injuries Annually 15,000 permanent spinal cord injuries Commonly men 16–30 years old Mechanism of Injury –Vehicle crashes: 48% –Falls: 21% –Penetrating trauma: 15% –Sports injury: 14% 25% of all spinal cord injuries occur from improper handling of the spine and patient after injury. –ASSUME based upon MOI that patients have a spinal injury. –MANAGE ALL spinal injuries with immediate and continued care. Lifelong care for spinal cord injury victim exceeds $1 million. Best form of care is public safety and prevention programs.

4 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Vertebral Column (1 of 10) 33 bones comprise the spine. Function: –Skeletal support structure –Major portion of axial skeleton –Protective container for spinal cord Vertebral Body: –Major weight-bearing component –Anterior to other vertebrae components

5 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Vertebral Column (2 of 10)

6 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Vertebral Column (3 of 10) Size of Vertebrae –C-1 and C-2: No vertebral body Support head Allow for turning of head –Vertebral body size increases the more inferior they become. Lumbar spine strongest and largest Bear weight of the body –Sacral and coccyx vertebrae are fused. No vertebral body

7 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Vertebral Column (4 of 10) Components of Vertebrae –Spinal Canal Opening in the vertebrae that the spinal cord passes through –Pedicles Thick, bony structures that connect the vertebral body to the spinous and transverse processes –Laminae Posterior bones of vertebrae that make up foramen –Transverse Process Bilateral projections from vertebrae Muscle attachment and articulation location with ribs

8 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Vertebral Column (5 of 10) Components of Vertebrae –Spinous Process Posterior prominence on vertebrae –Intervertebral Disk Cartilaginous pad between vertebrae Serves as shock absorber

9 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Vertebral Column (6 of 10) Vertebral Ligaments –Anterior Longitudinal Anterior surface of vertebral bodies Provides major stability of the spinal column Resists hyperextension –Posterior Longitudinal Posterior surface of vertebral bodies in spinal canal Prevents hyperflexion

10 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Vertebral Column (7 of 10) Cervical Spine –7 vertebrae –Sole support for head Head weighs 16–22 pounds –C-1 (Atlas) Supports head Securely affixed to the occiput Permits nodding –C-2 (Axis) Odontoid process (dens) Projects upward Provides pivot point so head can rotate –C-7 Prominent spinous process (vertebra prominens)

11 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Vertebral Column (8 of 10) Thoracic Spine –12 vertebrae –1st rib articulates with T-1 Attaches to transverse process and vertebral body –Next nine ribs attach to the inferior and superior portion of adjacent vertebral bodies Limits rib movement and provides increased rigidity –Larger and stronger than cervical spine Larger muscles help to ensure that the body stays erect Supports movement of the thoracic cage during respirations

12 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Vertebral Column (9 of 10) Lumbar Spine –5 vertebrae –Bear forces of bending and lifting above the pelvis –Largest and thickest vertebral bodies and intervertebral disks

13 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Vertebral Column (10 of 10) Sacral Spine –5 fused vertebrae –Form posterior plate of pelvis –Help protect urinary and reproductive organs –Attach pelvis and lower extremities to axial skeleton Coccygeal Spine –3–5 fused vertebrae –Residual elements of a tail

14 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Meninges Layers –Dura mater –Arachnoid –Pia mater Cover entire spinal cord and peripheral nerve roots that exit Cerebrospinal fluid bathes spinal cord by filling the subarachnoid space –Exchange of nutrients and waste products –Absorbs shocks of sudden movement

15 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Cord (1 of 4) Function –Transmits sensory input from body to the brain –Conducts motor impulses from brain to muscles and organs –Reflex center Intercepts sensory signals and initiates a reflex signal Growth –Fetus Entire cord fills entire spinal foramen –Adult Base of brain to L-1 or L-2 level Peripheral nerve roots pulled into spinal foramen at the distal end (cauda equina)

16 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Cord (2 of 4) Blood Supply –Paired spinal arteries Branch off the vertebral, cervical, thoracic, and lumbar arteries Travel through intervertebral foramina Split into anterior and posterior arteries

17 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Cord (3 of 4) General Cord Anatomy –Anterior Medial Fissure Deep crease along the ventral surface of the spinal cord that divides cord into left and right halves –Posterior Medial Fissure Shallow longitudinal groove along the dorsal surface –Gray Matter Area of the CNS dominated by nerve cell bodies Central portion of the spinal cord –White Matter Surrounds gray matter Comprised of axons

18 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Cord (4 of 4) General Cord Anatomy –Axons Transmit signals upward to the brain and down to the body Ascending tracts Axons that transmit signals to the brain Sensory tracts Descending tracts Axons that transmit signals to the body Motor tracts Voluntary and fine muscle movement

19 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

20 Spinal Anatomy and Physiology Spinal Nerves (1 of 11) 31 pairs of nerves that originate along the spinal cord from anterior and posterior nerve roots –Sensory and motor functions –Travel through intervertebral foramina 1st pair exit between the skull and C-1 Remainder of pairs exit below the vertebrae Each pair has 2 dorsal and 2 ventral roots –Ventral roots: motor impulses from cord to body –Dorsal roots: sensory impulses from body to cord –C-1 and Co-1 do not have dorsal roots

21 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Nerves (2 of 11) Plexus –Nerve roots that converge in a cluster of nerves Cervical plexus 5 cervical nerve roots Innervates the neck Produces the phrenic nerve Peripheral nerve roots C-3 through C-5 Responsible for diaphragm control “C3, 4, and 5 keep the diaphragm alive”

22 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Nerves (3 of 11) Brachial Plexus –C-5 through T-1 –Controls the upper extremity Lumbar and Sacral Plexuses –Innervation of the lower extremity

23 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Nerves (4 of 11)

24 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Nerves (5 of 11) Dermatomes –Topographical region of the body surface innervated by one nerve root –Key locations Collar region: C-3 Little finger: C-7 Nipple line: T-4 Umbilicus: T-10 Small toe: S-1

25 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Nerves (6 of 11)

26 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Nerves (7 of 11) Myotomes –Muscle and tissue of the body innervated by spinal nerve roots –Key myotomes Arm extension: C-5 Elbow extension: C-7 Small finger abduction: T-1 Knee extension: L-3 Ankle flexion: S-1

27 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Nerves (8 of 11) Reflex Pathways –Function Speed body’s response to stressors Reduce seriousness of injury Body stabilization –Occur in special neurons Interneurons Example Touch hot stove. Severe pain sends intense impulse to brain. Strong signal triggers interneuron in the spinal cord to direct a signal to the flexor muscle. Limb withdraws without waiting for a signal from the brain.

28 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Nerves (9 of 11)

29 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Nerves (10 of 11) Subdivision of ANS –Parasympathetic, “Feed and Breed” Controls rest and regeneration Peripheral nerve roots from the sacral and cranial nerves Major Functions Slows heart rate Increases digestive system activity Plays a role in sexual stimulation

30 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Anatomy and Physiology Spinal Nerves (11 of 11) Subdivision of ANS –Sympathetic, “Fight or Flight” Increases metabolic rate Branches from nerves in the thoracic and lumbar regions Major Functions Decreases organ and digestive system activity Vasoconstriction Release of epinephrine and norepinephrine Systemic vascular resistance Reduces venous blood volume Increases peripheral vascular resistance Increases heart rate Increases cardiac output

31 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Spinal Injury (1 of 14) Mechanisms of Spinal Injury –Extremes of Motion Hyperextension Hyperflexion: “Kiss the Chest” Excessive rotation Lateral bending

32 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Spinal Injury (2 of 14) Mechanisms of Spinal Injury –Axial Stress Axial loading Compression common between T-12 and L-2 Distraction Combination Distraction/rotation or compression/flexion –Other MOI Direct, blunt, or penetrating trauma Electrocution

33 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Spinal Injury (3 of 14)

34 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ

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43 Pathophysiology of Spinal Injury (4 of 14) Column Injury –Movement of vertebrae from normal position –Subluxation or dislocation –Fractures Spinous process and transverse process Pedicle and laminae Vertebral body –Ruptured intervertebral disks –Common sites of injury C-1/C-2: Delicate vertebrae C-7: Transition from flexible cervical spine to thorax T-12/L-1: Different flexibility between thoracic and lumbar regions

44 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Spinal Injury (5 of 14) Cord Injury –Concussion Similar to cerebral concussion Temporary and transient disruption of cord function –Contusion Bruising of the cord Tissue damage, vascular leakage, and swelling –Compression Secondary to: Displacement of the vertebrae Herniation of intervertebral disk Displacement of vertebral bone fragment Swelling from adjacent tissue

45 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Spinal Injury (6 of 14) Cord Injury –Laceration Causes Bony fragments driven into the vertebral foramen Cord may be stretched to the point of tearing Hemorrhage into cord tissue, swelling, and disruption of impulses –Hemorrhage Associated with contusion, laceration, or stretching

46 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Spinal Injury (7 of 14) Transection Cord Injury –Injury that partially or completely severs the spinal cord Complete Cervical Spine Quadriplegia Incontinence Respiratory paralysis Below T-1 Incontinence Paraplegia Incomplete

47 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Spinal Injury (8 of 14) Incomplete Transection Cord Injury –Anterior Cord Syndrome Anterior vascular disruption Loss of motor function and sensation of pain, light touch, and temperature below injury site Retain motor, positional, and vibration sensation –Central Cord Syndrome Hyperextension of cervical spine Motor weakness affecting upper extremities Bladder dysfunction –Brown-Sequard’s Syndrome Penetrating injury that affects one side of the cord Ipsilateral sensory and motor loss Contralateral pain and temperature sensation loss

48 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Spinal Injury (9 of 14) General Signs and Symptoms –Extremity paralysis –Pain with and without movement –Tenderness along spine –Impaired breathing –Spinal deformity –Priapism –Posturing –Loss of bowel or bladder control –Nerve impairment to extremities

49 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Spinal Injury (10 of 14) Spinal Shock –Temporary insult to the cord –Affects body below the level of injury –Affected area Flaccid Without feeling Loss of movement (flaccid paralysis) Frequent loss of bowel and bladder control Priapism Hypotension secondary to vasodilation

50 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Spinal Injury (11 of 14) Neurogenic Shock –Spinal-Vascular Shock –Occurs when injury to the spinal cord disrupts the brain’s ability to control the body Loss of sympathetic tone Dilation of arteries and veins Expands vascular space Results in relative hypotension Reduced cardiac preload Reduction of the strength of contraction Frank-Starling reflex ANS loses sympathetic control over adrenal medulla Unable to control release of epinephrine and norepinephrine Loss of positive inotropic and chronotropic effects

51 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Spinal Injury (12 of 14) Neurogenic Shock –Signs and Symptoms Bradycardia Hypotension Cool, moist, and pale skin above the injury Warm, dry, and flushed skin below the injury Male: priapism

52 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Spinal Injury (13 of 14) Autonomic Hyperreflexia Syndrome –Associated with the body’s resolution of the effects of spinal shock –Commonly associated with injuries at or above T-6 –Presentation Sudden hypertension Bradycardia Pounding headache Blurred vision Sweating and flushing of skin above the point of injury

53 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Pathophysiology of Spinal Injury (14 of 14) Other Causes of Neurologic Dysfunction –Any injury that affects the nerve impulse’s path of travel Swelling Dislocation Fracture Compartment syndrome

54 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Assessment of the Spinal Injury Patient (1 of 4) Scene Size-up –Evaluate MOI. –Consider spinal clearance protocol. –Determine type of spinal trauma. –Maintain suspicion with sports injuries. –If unclear about MOI, take spinal precautions.

55 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Assessment of the Spinal Injury Patient (2 of 4) Initial Assessment –Consider spinal clearance protocol. –Consider spinal precautions. Head injury Intoxicated patients Injuries above the shoulders Distracting injuries –Maintain manual stabilization. Vest style versus rapid extrication Maintain neutral alignment Increase of pain or resistance, restrict movement in position found

56 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Assessment of the Spinal Injury Patient (3 of 4) Initial Assessment –ABCs. –Suction. –Consider oral or digital intubation if required. Maintain in-line manual c-spine control.

57 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Assessment of the Spinal Injury Patient (4 of 4) Rapid Trauma Assessment –Focused versus rapid assessment –Rapid Assessment Suspected or likely spinal cord/column injury Multi-system trauma patient Evaluate for Neck Deformity, pain, crepitus, warmth, tenderness Bilateral extremities Finger abduction/adduction Push, pull, grips Motor and sensory function Dermatome and myotome evaluation Babinski’s sign test Hold-up position

58 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Babinski’s Sign Test Stroke lateral aspect of the bottom of the foot. Evaluate for movement of the toes. –Fanning and flexing (lifting) Positive sign Injury along the pyramidal (descending spinal) tract

59 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Assessment of the Spinal Injury Patient Vital Signs –Body temperature Above and below site of injury –Pulse –Blood pressure –Respirations Ongoing Assessment –Recheck elements of initial assessment. –Recheck vital signs. –Recheck interventions. –Recheck any neurological deviations.

60 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Clearance Protocol

61 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Spinal Integrity Terminology Stabilize is a word commonly used to describe protecting the spinal cord from possible injury (or further injury) when vertebral column integrity is disrupted. Immobilize refers to the “splinting” of the head, neck, and torso to limit any transmission of motion to the spine. Spinal motion restriction (SMR) is now suggested as a more accurate description of modern spinal injury care. However, this phrase could be misunderstood to indicate a more limited “immobilization” of the spine than is currently practiced.

62 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of the Spinal Injury Patient (1 of 7) Spinal Alignment –Move patient to a neutral, in-line position. Position of function. –Hips and knees should be slightly flexed for maximum comfort and minimum stress on muscles, joints, and spine. Place a rolled blanket under the knees. –ALWAYS support the head and neck. –Contraindications to neutral position: Movement causes a noticeable increase in pain. Noticeable resistance met during procedure. Increase in neurological deficits occurs during movement. Gross deformity of spine. –LESS MOVEMENT IS BEST.

63 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of the Spinal Injury Patient (2 of 7) Manual Cervical Immobilization –Seated Patient Approach from front. Assign a caregiver to hold GENTLE manual traction. Reduce axial loading. Evaluate posterior cervical spine. Position patient’s head slowly to a neutral, in-line position. –Supine Patient Assign a caregiver to hold GENTLE manual traction. Adult Lift head off ground 1–2”: neutral, in-line position. Child Position head at ground level: avoid flexion.

64 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of the Spinal Injury Patient (3 of 7)

65 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of the Spinal Injury Patient (4 of 7) Cervical Collar Application –Apply the C-collar as soon as possible. –Assess neck prior to placing. –C-collar limits some movement and reduces axial loading. –DOES NOT completely prevent movement of the neck. –Size and Apply according to the manufacturer’s recommendation. Collar should fit snugly. Collar should NOT impede respirations. Head should continue to be in neutral position. SIZE IT, SIZE IT, SIZE IT!!! –DO NOT RELEASE manual control until the patient is fully secured in a spinal restriction device.

66 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of the Spinal Injury Patient (5 of 7) Standing Takedown –Minimum 3 rescuers. –Have patient remain immobile. –Rescuer provides manual stabilization from behind. –Assess neck. –Size and place c-collar. –Position board behind patient. –Grasp board under patient’s shoulders. –Lower board to ground. –Secure patient. COMMUNICATE WITH PARTNERS AND PATIENT.

67 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of the Spinal Injury Patient (6 of 7) Helmet Removal –When to remove: Helmet does not immobilize the patient’s head within. Cannot securely immobilize the helmet to the long spine board. Helmet prevents airway care. Helmet prevents assessment of anticipated injuries. Present or anticipated airway or breathing problems. Removal will not cause further injury.

68 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of the Spinal Injury Patient (7 of 7) Helmet Removal –Technique: 2 Rescuers. Have a plan. Remove face mask and chin strap. Immobilize head. Slide one hand under back of neck and head. Other hand supports anterior neck and jaw. Remove helmet. Gently rock head to clear occiput. All actions should be slow and deliberate. –TRANSPORT HELMET with patient. –COMMUNICATION is the KEY.

69 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Movement of the Spinal Injury Patient (1 of 2) Any movement MUST be coordinated. Move patient as a unit. NO LATERAL PUSHING. –Move patient up and down to prevent lateral bending. Rescuer at the head “CALLS” all moves. ALL MOVES MUST be slowly executed and well coordinated. Consider the final positioning of the patient prior to beginning move.

70 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Movement of the Spinal Injury Patient (2 of 2) Types of Moves –Log roll –Straddle slide –Rope-Sling slide –Orthopedic stretcher –Vest-type immobilization –Rapid extrication –Final patient positioning –Long spine board –Full-body vacuum mattress –Diving injury immobilization

71 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of the Spinal Injury Patient (1 of 3) Medications and Spinal Cord Injury –Steroids if neuro-deficit is identified Reduce the body’s response to injury Reduce swelling and pressure on cord Administered within 1st 8 hours of injury

72 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of the Spinal Injury Patient (2 of 3) Medications and Neurogenic Shock –Fluid Challenge Isotonic solution: 20 mL/kg 250 mL initially Monitor response and repeat as needed –PASG Controversial Research shows no positive outcome –Dopamine 2–20 mcg/kg/min titrated to blood pressure –Atropine 0.5–1.0 mg q 3–5 min (maximum of 2.0 mg)

73 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Management of the Spinal Injury Patient (3 of 3) Medications and the Combative Patient –Consider sedatives to reduce anxiety and calm patient. Prevents spinal injury aggravation –Medications: Meperidine (Demerol) Diazepam (Valium) Consider paralytics with airway control

74 Bledsoe et al., Paramedic Care Principles & Practice Volume 4: Trauma © 2006 by Pearson Education, Inc. Upper Saddle River, NJ Summary Introduction to Spinal Injuries Spinal Anatomy and Physiology Pathophysiology of Spinal Injury Assessment of the Spinal Injury Patient Management of the Spinal Injury Patient


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