Immobilisation Flashcards
How long is the spinal cord?
42-45cm in length
Where does the spinal cord extend from?
The foramen magnum to the superior border of the second lumbar vertebra (L2)
What is the diameter of the spinal cord in terms of its varying sections?
2cm at the mid-thoracic point, little larger in both the inferior cervical and mid-lumbar enlargement and narrowest at the inferior tip
When using a semi-rigid cervical collar, what percentage of reduced movement is there?
31-45% (insufficient alone in protecting C-spine)
When using head blocks and straps, what percentage reduced movement?
58-64% (not beneficial with collar)
When using a cervical collar what needs to be taken into consideration?
Intracranial pressure
What is a better alternative to long boards in terms of reducing rotational movement and where time is not critical?
The Kendrick extrication device (KED)
Scoop stretcher is safest option
How long should a patient be strapped to a long board?
45 mins
When should log rolling be avoided?
When there is a suspicion of a pelvic fracture as it may disrupt blood clots and promote further bleeding
What are some hazards and complication associated with spinal immobilisation? (6)
Airway problems (including increased risk of aspiration)
Increase intracranial pressure
Restricted respiration
Dysphagia (difficulty in swallowing)
Skin ulceration
Pain
What Increases risk of increased aspiration?
A supine trauma patient (face up)
What should be done when a trauma patient is vomiting?
Use four people to perform a log roll and one person on suction
One person holds the head and coordinates roll, while other three roll the chest, pelvis and limbs to keep head, neck, body and limbs in an aligned manner
Why does correctly fitted cervical collars cause an increase in intracranial pressure? And what does evidence suggest?
They reduce venous return from the head.
Evidence suggests that in patients with head injuries, loosening the cervical collar once the patient is securely on the board may prevent compromise of venous return and exacerbation of raised intracranial pressure
What an restricted chest expansion cause?
Low tidal volumes and exacerbate the psychological effects of the supine position on respiratory function.
What is the purpose of the supine position in terms of patients?
Leads to a reduced functional residual capacity and means that fewer alveoli are available for external respiration
What is ischaemia?
It is when the pressure between the immobilisation device and the skin exceeds or approaches capillary pressure.
Inadequate blood supply to an organ or body part.
Where does a cervical spine collar need to be placed or sit?
On the chest, posterior thoracic spine and clavicle, and trapeziums muscle to be effective
How is the head immobilised using the cervical collar?
It is immobilised by the collar beneath the mandible and at the occiput
What happens if the collar is too small?
It won’t restrict flexion motion of the neck
What happens if the collar is too big?
It may cause hyperextension or allow for greater motion of the chin slips inside the front piece of the collar
If a collar cannot be used due to not being able to maintain a neutral alignment, what should be done?
Improvise using blankets or towels
When would a Kendrick Extrication Device (KED) be used?
When spinal immobilisation is indicated for a sitting patient with non-time critical injuries
How should a KED be attached to a patient?
Discuss procedure and get consent from patient
Paramedic behind patient to hold head where possible
Paramedic 2 checks neurological and vascular response of all extremities and then measured and applies cervical collar
KED is skid into position behind patient and wrapped around. Side flaps should be touching patients armpits
Middle chest strap positioned and fastened
Lower chest strap positioned and fastened
Upper chest is optional at this time but should not be secured too tightly if used. Should be fastened just before patient is moved
Groin straps should be positioned and fastened taking care not to trap the patients genitalia. Can be achieved by working the strap in a backwards-and-forwards motion under patients thigh and buttock until it sits comfortable in the integluteal fold. Once in place, straps are tightened.
May be necessary to reappraise the torso straps and adjust as necessary
Use padding behind patients head to maintain neutral alignment. Position head flaps and, using the head straps, secure patients head
Recheck all straps before moving and ensure that top chest strap has been connected
If possible, ambulance cot should be placed close to patient with either a long board or vacuum mattress placed upon it
Best option is to place long board beneath the patients buttocks with foot end securely placed on patients seat (ie. car seat) and the head end on the ambulance cot. If this cannot be achieved, patient may need to be lifted into position.
Rotate patient so their back is towards the long board. The legs will need to be lifted as the patient is extricated
Once square to the board, patient can be lowered to the board whilst keeping the legs elevated. The two groin straps need to be released at this point and the patients legs can be lowered
Patient should be positioned appropriately on the board and secured for transportation
Paramedic should consider releasing the top chest strap at this point
How would you use a long board?
Explain procedure and gain consent
Apply any appropriate cervical collar or extrication devise
Prepare board. Head pad should be in place and straps connected to their respective clip pins but the buckles should be unfastened
Use appropriate technique to place patient on long board. The patient should be located centrally on the board with the head on the head pad to maintain neutral alignment
Use blanket rolls to fill voids between sides of the patient and the sides of the board
Apply body straps in following order: chest, pelvis, thighs, ankles, head immobiliser and straps
Lift patient onto a suitable ambulance cot using the side lifting handles of the long board
Loosen cervical collar
Document the time the patient was on the board
How do you use a vacuum mattress?
Explain procedure and gain consent
Apply any appropriate cervical collar or extrication device
Prepare the mattress. Smooth out the beads in the mattress and undo the straps and lay by the side
Using appropriate technique, place the patient on the vacuum mattress (an orthopaedic stretcher may be used to achieve this). This is often an approparite point for location do the patients shoulders on the mattress. Paramedic should ensure that patient is correctly aligned.
Conform vacuum mattress around the contour of patient, starting at the head
Apply body straps in following order: chest, pelvis, tights, ankles
Evacuate air from the vacuum mattress until it becomes rigid; ensureattress remains rigid
Disconnect vacuum pump and ensure that the valve is closed and secured
Reassess and adjusts the straps around the chest, hips, and legs
Stabilise the head in neutral position and secure to vacuum mattress LAST
Reassess patients baseline obs
Lift patient onto suitable ambulance cot using side lifting handles of vacuum mattress
Loosen the cervical collar
Document the time the patient was placed on device
In what order is a KED attached? (6)
First put on collar by measuring patients neck with the fingers
Put the KED behind patient and follow “My Baby’s Looking Hot Tonight”.
Middle strap
Bottom straps
Leg straps around thighs
Head straps
Top strap
