LO6 Spinal Trauma (Chapter 10) Flashcards
Clearing C-spine
Unconscious or unreliable
Pin point pain or pain mid neck
Move head side to side up and down
Numbness tingling in extremities hand grips and pedal
The spinal column is a boney tube composed of
33 vertebrae
7 cervical C-spine, 12 thoracic T spine, 5 lumbar L spine and the remainder fused together as a posterior portion of the pelvis (5 sacral, 4 coccygeal)
The spinal cord is also an integrating center for the automatic nervous system which assist in
controlling heart rate, blood vessel tone, and blood flow to the skin injury in this component of the spinal cord result in neurogenic shock
Mechanisms of Blunt Spinal Column Injury
Sudden movement of the head or trunk will produce stresses that can damage the boney or connective tissue components of the spinal column
It requires a significant amount of force unless there is a pre-existing weakness or defect in the bone
Spinal column injury can occur without injuring the spinal cord
Hyperextension
Hyperflexion
Compression
Rotation
Lateral stress
Distraction
excessive posterior movement of the head or neck
excessive anterior movement of the head onto chest
Weight of had her pelvis driven into stationary neck or torso
excessive rotation of the torso or head and neck moving one side of the spinal column against the other
Direct lateral force on spinal column typically shearing one level of cord from another
excessive stretching of column and cord
primary spinal cord injury
occurs at the time of the trauma itself
it results from the cord being cut, torn or crushed or by its blood supply being cut off
the damage is usually irreversible despite the best trauma care
secondary spinal cord injury
occurs from poor perfusion, generalized hypoxemia, injury to blood vessels, swelling, compression of the cord from surrounding hemorrhage, or injury to the cord from movement of unstable spinal column
Neurogenic shock
Injury to the cervical thoracic spinal cord can produce shock as a result of a relative hypovolaemia
results from the motor function of the autonomic nervous system in regulating blood vessel tone and cardiac output
Mechanism of shock for spinal cord injury
the injury to the spinal cord destroys the ability of the brain to regulate the release of catecholamines from the adrenals
This drop in preload of the heart causes the blood pressure to fall the brain cannot correct this because it cannot get the message to the adrenal glands
The patient with neurogenic shock cannot show the signs of pale skin, tachycardia and sweating because the cord injury prevents release of catecholamines
Treatment of neurogenic shock
focussed on the fluid resuscitation to maintain perfusion and prevent secondary injury to the nervous system
Examination of the patient includes these elements:
pain
numbness
tenderness
painful movement
deformity
lacerations, hole or skin wounds
paralysis
Two types of situations require modification of the usual SMR
the patient who is an immediate danger of death in a hostile environment or in immediate life-threatening position in a structure or vehicle may require emergency rescue
Patients whose last primary survey indicates a critical degree of ongoing danger that requires an intervention within one or two minutes including: airway obstruction, cardiac respiratory arrest, Chest or airway injuries requiring ventilation, or deep shock/bleeding that cannot be controlled
Airway intervention
When the rescuer performs SMR in any manner the patient loses some of their ability to maintain the airway
The rescuer mustard assume this responsibility until the patient has controlled airway or has spinal column cleared in the emergency department and is released from the SMR
When weighing the risks and benefits of each area procedure recall the risks of dying with an uncontrolled airway is greater than risks of inducing spinal cord damage using a careful approach to intubation
Prone, seated and standing patients
Prone, seated, and standing patients are stabilized in a manner that minimize the spinal column movement ending with the patient in the conventional supine position
Prone patients are either log rolled onto backboard with careful coordination or moved using a scoop stretcher
Seated patient may be stabilized using short backboards if they have any indication for SMR
Standing patients do not need to be placed on a spine board especially if they’re ambulatory on scene
Four main reasons to consider field athletic helmet removal are:
Facemask cannot be removed in a timely fashion
Airway cannot be controlled due to design of the helmet and chinstrap
Helmet and chin straps do not hold the head securely
helmet prevent stabilization for transport in an appropriate position
