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Published byHenry Douglas Modified over 10 years ago
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Neck & Back injuries
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33 in total Physiology
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C3-5 keep the diaphragm alive T attach to ribs (stronger) Which is weakest? (C? T? L?) Weakest during side-to- side movement Physiology
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Mechanism Of Injury (speed/force, direction) Get as much info as possible! (Bystanders?) – pass onto crew Examples? Lateral forces more damaging Common injury sites: C1/2, C7/T1, T12/L1 50% to cervical region Pathophysiology
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Danger – traffic, people, animals Response – AVPU (think about where you stand when talking) Summon help Airway (& C-spine) Breathing Circulation Dysfunction Exposure Assessment (Primary Survey!!)
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To immobilise or not to immobilise If M.O.I suggests immobilise, do it. Airway (& C-spine)
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Neutral alignment (adults / children) What if there’s pain / resistance? Jaw thrust (2 movements) – why? (Avoid causing axial pressure) What if jaw thrust doesn’t work?? Airway (& C-spine) - Immobilised
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Are they breathing?? Rate, ease, depth, regularity (might be affected by spinal cord injury) Breathing
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Neurogenic shock → slow pulse & low BP Changes in skin colour Circulation
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Look Feel (Move) Dysfunction: Assessment Pain Tenderness Irregularity Sensation Parasthesia? Movement Odd sensations Keep Pt calm!!
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Priaprism
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25% of spinal cord injuries result from improper handling after injury DRS A,B 999! LOG ROLL – why/when? Reassure Obs / mental status (beyond AVPU) Management
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To immobilise or not to immobilise? What influences this? Airway (& C-spine)
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Normal mental status No neurological deficit No spinal pain / tenderness No evidence of intoxication No extremity injury If in doubt, immobilise !! If M.O.I suggests spinal injury… IMMOBILISE C-spine Clearing Protocols (YAS) Decreased consciousness (GCS <15)? L.O.C? Neurological S&S (tingling, numbness…)? SIGNIFICANT neck/back pain? Deformity, swelling, tenderness? SIGNIFICANT pain on moving neck/back? Drink/drugs (inc. prescribed)? Other painfull (distracting) injuries?
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Scenarios
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http://www2.warwick.ac.uk/fac/med/research/hsri/em ergencycare/prehospitalcare/jrcalcstakeholderwebsit e/guidelines/clinical_guidelines_2006.pdf http://www2.warwick.ac.uk/fac/med/research/hsri/em ergencycare/prehospitalcare/jrcalcstakeholderwebsit e/guidelines/clinical_guidelines_2006.pdf If you’re bored…
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