Immobilisation

Question 1

How long is the spinal cord?

Answer 1

42-45cm in length

Question 2

Where does the spinal cord extend from?

Answer 2

The foramen magnum to the superior border of the second lumbar vertebra (L2)

Question 3

What is the diameter of the spinal cord in terms of its varying sections?

Answer 3

2cm at the mid-thoracic point, little larger in both the inferior cervical and mid-lumbar enlargement and narrowest at the inferior tip

Question 4

When using a semi-rigid cervical collar, what percentage of reduced movement is there?

Answer 4

31-45% (insufficient alone in protecting C-spine)

Question 5

When using head blocks and straps, what percentage reduced movement?

Answer 5

58-64% (not beneficial with collar)

Question 6

When using a cervical collar what needs to be taken into consideration?

Answer 6

Intracranial pressure

Question 7

What is a better alternative to long boards in terms of reducing rotational movement and where time is not critical?

Answer 7

The Kendrick extrication device (KED)

Scoop stretcher is safest option

Question 8

How long should a patient be strapped to a long board?

Answer 8

45 mins

Question 9

When should log rolling be avoided?

Answer 9

When there is a suspicion of a pelvic fracture as it may disrupt blood clots and promote further bleeding

Question 10

What are some hazards and complication associated with spinal immobilisation? (6)

Answer 10

Airway problems (including increased risk of aspiration)

Increase intracranial pressure

Restricted respiration

Dysphagia (difficulty in swallowing)

Skin ulceration

Pain

Question 11

What Increases risk of increased aspiration?

Answer 11

A supine trauma patient (face up)

Question 12

What should be done when a trauma patient is vomiting?

Answer 12

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

Question 13

Why does correctly fitted cervical collars cause an increase in intracranial pressure? And what does evidence suggest?

Answer 13

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

Question 14

What an restricted chest expansion cause?

Answer 14

Low tidal volumes and exacerbate the psychological effects of the supine position on respiratory function.

Question 15

What is the purpose of the supine position in terms of patients?

Answer 15

Leads to a reduced functional residual capacity and means that fewer alveoli are available for external respiration

Question 16

What is ischaemia?

Answer 16

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.

Question 17

Where does a cervical spine collar need to be placed or sit?

Answer 17

On the chest, posterior thoracic spine and clavicle, and trapeziums muscle to be effective

Question 18

How is the head immobilised using the cervical collar?

Answer 18

It is immobilised by the collar beneath the mandible and at the occiput

Question 19

What happens if the collar is too small?

Answer 19

It won’t restrict flexion motion of the neck

Question 20

What happens if the collar is too big?

Answer 20

It may cause hyperextension or allow for greater motion of the chin slips inside the front piece of the collar

Question 21

If a collar cannot be used due to not being able to maintain a neutral alignment, what should be done?

Answer 21

Improvise using blankets or towels

Question 22

When would a Kendrick Extrication Device (KED) be used?

Answer 22

When spinal immobilisation is indicated for a sitting patient with non-time critical injuries

Question 23

How should a KED be attached to a patient?

Answer 23

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

Question 24

How would you use a long board?

Answer 24

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

Question 25

How do you use a vacuum mattress?

Answer 25

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

Question 26

In what order is a KED attached? (6)

Answer 26

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