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Unit 35 Spinal Injuries.

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Presentation on theme: "Unit 35 Spinal Injuries."— Presentation transcript:

1 Unit 35 Spinal Injuries

2 Overview Spinal column instability Mechanism of injury
Types of spinal cord injuries Signs and symptoms of spinal injury Manual stabilization Spinal immobilization principles

3 Introduction Spinal cord injuries can leave patients with devastating neurologic injuries Injuries can lead to permanent disability, paralysis, and death Care provided by EMT has crucial impact on patient’s long-term outcomes EMT must recognize spine injuries

4 Anatomy Review Cervical spine Spinal column in the torso
Cervical vertebrate Spinal column in the torso Thoracic and lumbar vertebrate Figure 35.1 The spinal vertebrae are segments of bone, with a spinal lumen or canal for the spinal cord

5 Anatomy Review Spinal cord Nerve roots and dermatomes Anterior cord
Central cord Posterior cord Nerve roots and dermatomes Sensory and motor nerves Dermatome: map of spinal nerves and associated areas of sensation

6 Spinal Column Instability
Injuries to cervical spine can be life threatening or have lifelong implications Hyperflexion: excessive forward bending of neck Hyperextension: excessive backward bending of neck Lateral bending: due to side impact

7 Spinal Column Instability (cont’d.)
Axial loading: sudden downward pressure causing compression Axial distraction: cervical spine is pulled apart Figure Axial loading can occur from force applied from above, such as when the top of the head impacts with the windshield of a car

8 Mechanism of Injury Motor vehicle collision Falls Gun shot wounds
Force may cause motion beyond normal range, damaging spinal column Falls Force of fall may fracture or burst bones resulting in spinal cord injury Gun shot wounds Bullet strike to spinal column will likely cause trauma and spinal cord injury

9 Mechanism of Injury (cont’d.)
Sports injuries Collisions occurring during sports can result in force, causing injury Associated injuries EMT must consider spinal injury, if trauma sustained by body part close to spine Assume trauma occurring above clavicles, to chest or abdomen, may also involve spine injury

10 Types of Spinal Cord Injuries
Spinal cord injury may result in lacerations, compression, and stretching Primary spinal cord injury: occurs at time of incident Secondary spinal cord injuries: result from improper handling of patient with potential spinal cord injury

11 Signs and Symptoms of Spinal Injury
Neck pain Tenderness along spine Obvious deformity of spine Figure Point tenderness elicited by palpation of the posterior neck. Note that the patient has continuous manual stabilization

12 Signs and Symptoms of Spinal Injury (cont’d.)
Respiratory distress or arrest Diaphragm may stop contracting Signs: extreme shortness of breath, respiratory difficulty, or apnea Neurogenic shock Caused by loss of nervous system control of blood pressure Results in relative blood loss and hypotension

13 Figure 35.19 Neurogenic shock is notable by distal vasodilation,
manifest by warm and flushed skin, and bradycardia

14 Signs and Symptoms of Spinal Injury (cont’d.)
Paralysis Depending on location of spinal cord injury, areas affected by paralysis differ Quadriplegia, paraplegia, and paresthesia Associated signs of spinal cord injury Loss of control of bowels and/or bladder Priapism: painful erection

15 Primary Assessment Always protect spine from further injury
High-priority: full spine immobilization and immediate transport Low priority: proceed to secondary assessment at more measured pace

16 Considerations When Deciding on Spinal Immobilization
Any patient with significant mechanism of injury and distracting injury should be treated for spine injury Assume spinal injury if patient is found unconscious and no one witnessed what caused patient’s condition

17 Manual Stabilization Goal: prevent further injury to spine
Neutral inline alignment Reposition head and neck to natural anatomic position Figure Neutral inline alignment of the cervical spine

18 Distal Neurologic Function
Assesses peripheral neurologic function Check extremities for movement and sensation Look for signs of distal circulation Confirm distal circulation, sensation, and movement (CSM) before and after patient is placed on long backboard

19 Cervical Spine Immobilization Device
Cervical collar: semi-rigid device used to maintain neutral inline alignment Application of the cervical spine immobilization device Move chin cup up chest until chin is trapped, then attach Velcro®

20 Special Problem of Helmets
Important for EMT to know whether it is safer to take helmet off or leave on Keep helmet in place if well fitted and does not impede management of airway, breathing, and immobilization Remove loose fitting helmets

21 Spinal Immobilization Principles
Immobilize entire length of spine using long backboard Head immobilization Head secured last to prevent neck injury Pediatric challenges Pediatric immobilization boards have dip in head section, allowing for child’s larger occiput Geriatric challenges Use padding for curvature of spine

22 Moving Patient to Long Backboard
Patient lying down Four-person lift and slide Long axis drag Modified log roll Orthopedic stretcher

23 Moving Patient to Long Backboard (cont’d.)
Seated patient Use intermediate device to move patient Rapid extrication Remove seated patient quickly Short spinal immobilization device Secures spine in upright position Standing patient Perform standing takedown technique

24 Selective Spinal Immobilization
Selective spinal immobilization criteria Negative mechanism of injury does not meet criteria Isolated foot injury Uncertain mechanism of injury requires further assessment to meet criteria Slip and fall Positive mechanism of injury meets criteria High velocity motor vehicle impact

25 Selective Spinal Immobilization (cont’d.)
Assessment by clinical criteria Determine neck pain, and extremity sensation and motor function Unreliable patient examination Use caution and immobilize patient Preexisting medical conditions Elderly patient may have brittle bones

26 Transport Pay special attention and handle patient gently
Provide extra padding Get patient safely to most appropriate hospital in reasonable amount of time Perform ongoing assessment

27 Conclusion EMT’s quick recognition of potential for spinal cord injury can help prevent further damage from occurring Careful immobilization while maintaining inline stabilization is key in managing patient who has sustained spinal injury

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