EAC Injuries to the Pelvis and Spine

Question 1

3 causes of pelvic injury

Answer 1

Direct force

Indirect force

Muscular action

Question 2

define:

Direct force pelvic injury

Answer 2

When a bone breaks at the point where the force is applied i.e. crush or impact injury

Question 3

define:

Indirect force pelvic injury

Answer 3

When the bone breaks at some distance from the point where force has been applied i.e. heavy landing on feet damaging pelvis

Question 4

define:

Muscular action pelvic injury

Answer 4

Where there is violent contraction of muscles often pulling the pelvis out of alignment

Question 5

signs and symptoms of:
Pelvic Fracture
(these being present may indicate use of Prometheus Pelvic Splint PPS)

Answer 5

Severe pain from the back of the pelvis
Inability to stand
Rigidity of abdomen (internal bleeding)
Legs in an unnatural position
Feeling of pelvic cavity lying ‘open’ or ‘falling apart’
High index of suspicion based on mechanism and/or other associated injuries
Abnormal mobility to pelvic region
Swelling
Urge to pass urine
Blood in patients urine
Deformity
Bruising or swelling over the bony prominences, pubis, perineum or scrotum.
Leg length discrepancy or rotational deformity of a lower limb (without fracture in that extremity) may be evident.
Wounds over pelvis or bleeding from rectum, vagina, urethra may indicate an open pelvic fracture.
Altered sensation in one leg.

Question 6

management of:

Pelvic Injury

Answer 6

Ensuring open airway
Administering high % O2
Relieving pain with Entonox
Warning the pt not to pass urine; doing so may tear the bladder as it empties
Making the pt comfortable and providing support to the injury
Avoiding ‘springing’ the pelvis, as this may cause catastrophic bleeding
Using plenty of padding
Immobilising the knees and ankles to prevent movement of the legs
Constantly reassuring and observing pt
Provide a smooth journey to hospital

Question 7

complications of:

Pelvic injury

Answer 7

Damage to:
Major blood vessels
Nerves
Organs i.e. bladder, urethra, reproductive organs

Question 8

location of the Greater Trochanter

primary landmark needed to use PPS

Answer 8

The boney prominence on the lateral aspect hip

NOT the iliac crest which is too high.

roughly where pt’s wrist will lay if pt’s arm is lain by their side.

Question 9

Application of the Prometheus Pelvic Splint PPS

Answer 9

Apply PPS in conjunction with scoop to avoid rolling pt twice.

Bright yellow side on outside

Black side against pt’s skin

PPS placed in L shape and passed under the pt by method of log roll no more then 10 degrees tilt.

Place blue triangle of one side over greater trochanter and cut splint to length (approx. line of blue triangle). Then same on other side.

Two staff either side of pt to pull tabs up and away from pt. taking care not to over compress the pelvis.

The tabs are then secured to the wide yellow band.

Secure feet with triangular bandage.

Can be used in conjunction with the Kendrick Traction Splint if there is a concurrent fractured femur. PPS applied 1st.

CAN NOT be used with the sager traction splint

Question 10

Prometheus Pelvic Splint can be used…

Answer 10

ONCE - single use device

Question 11

3 types of Spinal Injury

Answer 11

Dislocation of the vertebrae

Fracture of the vertebrae

Displaced intervertebral disc

Question 12

complications of:

Injury to the Spine

Answer 12

Damage to spinal cord
Compression of spinal cord
Spinal shock
Neurogenic shock
Respiratory difficulties
Cauda Equina syndrome

Question 13

Define:

Cauda Equina syndrome

Answer 13

The Cauda Equina (Latin for “horse’s tail”) is a bundle of spinal nerves and spinal nerve roots.

This is a ‘Spinal Emergency’. It occurs when the nerves below the spinal cord are compressed. The nerves that supply the bladder and bowels also supply sensation to the skin around the bottom and back passage.

Question 14

red flags associated with:

Cauda Equina

Answer 14

Any of the following are significant in the presence of lower back pain and/or unilateral or bilateral lower limb pain, radiating from the lower back:

Numbness in the groin/perineum/buttocks

Bladder or bowel dysfunction

Sexual dysfunction

Lower limb weakness and/or sensory deficit (disturbed gait/inability to walk)

Reduced or absent lower limb reflexes

Question 15

signs and symptoms of:

Spinal Injury

Answer 15

As well as usual signs and symptoms of fracture:

Loss of feeling or sensation in the body below the site of injury

Tingling, or pins and needles sensation above the site of injury

Paralysis below the site of injury often accompanied by loss of internal muscle control which causes incontinence

Displacement of a spinal vertebrae felt as an unnatural lump, or depression, from the normal continuity of the spinal column

fixation of the spinal column at the site of the injury

priapism

diaphragmatic or abdominal breathing

cardiac arrest

Question 16

management of:

Spinal Injury

Answer 16

DRABCDE

ensuring an open airway by jaw thrust and maintaining a neutral alignment position

High % O2 (major trauma)

supporting the head and neck and applying a cervical collar.

Consider HEMS/BASICS etc

Transfer to hospital with pre-alert if time critical

If time permits; carrying out a secondary survey to establish the site of injury

consider the use of Entonox to relieve pain and other analgesia

handling slowly and carefully to avoid any jarring or rotation of the head and lower limbs

avoiding rotation or angulation of the spine

Immobilising the lower limbs at the knees and ankles

securing upper limbs to prevent movement

applying a spinal board

lifting the pt carefully using specialist lifting equipment and avoiding and unnecessary movement

positioning the pt with adequate spinal support

conveying slowly and smoothly taking account of adverse road conditions

Get a thorough History of the accident and the mechanism of injury

Do not rush unless life is in obvious danger

Question 17

List the stages of the JRCALC immobilisation algorithm

Answer 17

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