1. Neck & Back injuries

2. 33 in total Physiology

3.  C3-5 keep the diaphragm alive  T attach to ribs (stronger)  Which is weakest? (C? T? L?)  Weakest during side-to- side movement Physiology

4.  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

5.  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!!)

6.  To immobilise or not to immobilise  If M.O.I suggests immobilise, do it. Airway (& C-spine)

7.  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

8.  Are they breathing??  Rate, ease, depth, regularity (might be affected by spinal cord injury) Breathing

9.  Neurogenic shock → slow pulse & low BP  Changes in skin colour Circulation

10.  Look  Feel  (Move) Dysfunction: Assessment Pain Tenderness Irregularity Sensation Parasthesia? Movement Odd sensations Keep Pt calm!!

11. Priaprism

12.  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

13.  To immobilise or not to immobilise? What influences this? Airway (& C-spine)

14.  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?

15. Scenarios

16.  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…