Anatomy and Physiology Vertebral Column Spinal Cord
Skeletal Injuries Compression fractures of vertebra Fractures that produce small fragments of bone Subluxation: partial dislocation of a vertebra from its normal place in spinal column Overstretching or tearing of ligaments and muscles
Injuries to the Spine Varied mechanisms of injury (flexion, extension, rotation, distraction, compression, lateral flexion, combination of forces) Mostly blunt, some penetrating Spinal cord injury obviously feared, particularly for cervical spine Range from unstable injuries to stable
Common causes of spinal cord injury Motor vehicle accidents. Acts of violence. Falls. Sports and recreation injuries. Diseases.
Indications for Spinal Immobilization Altered Level of Consciousness Traumatic Brain Injuries (TBI) Altered Mental Status other than TBI Acute Stress Reaction Spinal Pain or Tenderness Neurologic Deficit or Complaint Anatomic Deformity of the Spine
Signs and Symptoms The signs and symptoms of a spinal cord injury depend on two factors: 1. The location of the injury. 2. The severity of the injury. Spinal cord injuries are classified as partial or complete, depending on how much of the cord width is damaged. 1. A partial spinal cord injury, which may also be called an incomplete injury, the spinal cord is able to convey some messages to or from the brain. 2. A complete injury is defined by complete loss of motor function and sensation below the area of injury.
Signs and Symptoms Paralysis of extremities (The most reliable sign in conscious patient) Pain with/without movement Tenderness anywhere along the spine Impaired breathing Deformity Priapism Posturing Loss of bowel or bladder control Nerve impairment to the extremities Severe spinal shock Soft tissue injury associated with trauma
Diagnostic Procedures X-rays. Computerized tomography (CT) scan: is beginning to become the study of choice in many trauma centers and emergency departments Magnetic resonance imaging (MRI). Myelography.
Emergency Care Steps Manual stabilization for head and neck Assess A, B & C Assess head & Neck and apply rigid cervical collar Assess sensory & motor function in all extremities Apply appropriate spinal immobilization device Administer Oxygen via NRM if patient has paralysis or weakness. Reassess motor and sensory in all extremities
Steroid Protocol for Spinal Cord Injury Solumedrol 30 mg/kg bolus followed by infusion 5.4 mg/kg/hr for next 23 – 48 hours Controversy exists