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Overview
• Spinal column instability
• Mechanism of injury
• Types of spinal cord injuries
• Signs and symptoms of spinal injury
• Manual stabilization
• Spinal immobilization principles
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
Anatomy Review
• Cervical spine– 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
Anatomy Review
• Spinal cord– Anterior cord– Central cord – Posterior cord
• Nerve roots and dermatomes– Sensory and motor nerves– Dermatome: map of spinal nerves and
associated areas of sensation
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
Spinal Column Instability (cont’d.)
• Axial loading: sudden downward pressure causing compression
• Axial distraction: cervical spine is pulled apart
Figure 35.11 Axial loading can occur from force applied from above, such as when the top of the head impacts with the windshield of a car
Mechanism of Injury
• Motor vehicle collision– 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
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
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
Signs and Symptomsof Spinal Injury
• Neck pain
• Tenderness along spine
• Obvious deformity of spine
Figure 35.17 Point tenderness elicited by palpation of the posterior neck. Note that the patient has continuous manualstabilization
Signs and Symptomsof 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
Figure 35.19 Neurogenic shock is notable by distal vasodilation,manifest by warm and flushed skin, and bradycardia
Signs and Symptomsof 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
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
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
Manual Stabilization
• Goal: prevent further injury to spine
• Neutral inline alignment– Reposition head and
neck to natural anatomic position
Figure 35.24 Neutral inlinealignment of the cervical spine
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
Cervical SpineImmobilization 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®
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
Spinal ImmobilizationPrinciples
• 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
Moving Patientto Long Backboard
• Patient lying down– Four-person lift and slide– Long axis drag– Modified log roll– Orthopedic stretcher
Moving Patientto 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
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
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
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