MOD E Tech 31 Injuries to the Spine and Pelvis

Question 1

Functions of the Vertebrae

Answer 1

• Movement
• Support
• Shock absorber
• Attachment
• Protection

Question 2

Anatomy of the Spinal Cord

Answer 2

• Extends from medulla to upper border of L2
• 45 cm long
• Approx. thickness of little finger
• 2 enlargements – cervical and lumbar
• Protected by spinal column

Question 3

Functions of the Spinal Cord

Answer 3

•Relay impulses

–Impulses enter and leave the spinal cord

–Messages to and from the brain

–Centre of reflex action

Question 4

Types of Injury spinal

Answer 4

Vertebral Injury – dislocation, fracture, displaced

Muscular Injury

Spinal Cord Injury (SCI)

Question 5

Common points of Injury

Answer 5

Junctions of fixed and mobile sections;

Older patient: Odontoid peg fracture

C5, C6, C7, T1

or T12, L1

Question 6

Mechanism of Spinal Injury

Answer 6

• Hyperextension
• Hyperflexion
• Axial loading (head or feet first)
• Lateral stress or distraction (hanging)
• Less common

Question 7

High Risk Mechanisms

spinal

list

Answer 7

Road Traffic Collisions:

• Rollover RTC
• Non-wearing of seatbelts
• Ejection from vehicle
• Struck by vehicle

•

Falls:

• Older people
• Rheumatoid arthritis

Sporting Injuries:

• Diving into shallow water
• Horse riding
• Rugby
• Gymnastics & trampolining

Question 8

Spinal Cord Injury

Answer 8

•Primary Injury

–Damage is immediate and irreversible. Cord is cut, torn or looses blood supply

–

•Secondary Injury

–Cord injury develops later from

•Hypoxia, swelling, hypotension or compression of the blood supply

Good patient care limits secondary injury

Question 9

Spinal Cord Injury Assessment

Answer 9

• Assess sensory and motor function
• Examine upper limbs and hands
• Examine lower limbs and feet
• Examine both sides

Question 10

Spinal Cord Injury

Signs and Symptoms

Answer 10

• Neck or back pain
• Loss of sensation below the site of injury
• Sensation of burning / tingling in the trunk or limbs
• Paralysis below the site of injury
• Incontinence
• Displacement of vertebrae
• Fixation of the spinal column
• Diaphragmatic breathing
• Hypotension with a bradycardia
• Warm peripheries or vasodilation in the presence of a low BP

Question 11

Neurogenic Shock

signs

Answer 11

• Decrease in BP
• No change or decrease in heart rate
• Warm, dry flushed skin below the point of injury

Question 12

Worrying History (Spine?)

Answer 12

• Downs Syndrome (ligamentous laxity)
• Dwarfism (Spinal stenosis / Scoliosis)
• Ankylosing spondylitis
• Brittle Bones
• Rheumatoid Arthritis, Osteoporosis
• Cachectic or Anorexic
• Osteoarthritis
• Intoxicated
• Over 70
• Multiple Sclerosis or Cerebral Palsy

Question 13

Spinal Cord Injury Management

Answer 13

• ABCD
• Early manual immobilisation
• Jaw thrust
• High flow O2
• Apply a rigid collar – maintain head and neck stability until secured to an immobilisation device
• If immobilisation is indicated, immobilise the whole spine
• Immobilise all unconscious trauma victims
• Immobilise on a scoop stretcher
• Long/spinal board should only be used an extrication device
• Secondary survey to establish site of injury

Question 14

Exclusion of immobilisation

Answer 14

• GCS 15
• No evidence drug or alcohol use
• No Complaints of spinal pain
• No Vertebral tenderness or deformity
• No neurological deficits
• No distracting injuries
• No worrying history

Question 15

Spinal Cord Injury Special Situations

Answer 15

• Prone and standing patients
• Paediatric patients
• Elderly patients
• Pregnant patients
• Obese patients
• Patients in protective helmets
• Patients in immediate danger
• Confused, combative patients

Question 16

Cauda equina syndrome

Answer 16

Caused by compression

• Low back pain
• Unilateral or Bilateral sciatica
• Saddle paraesthesia
• Loss of sphincter tone (bladder and bowel incontinence)
• Lower extremity muscle weakness and loss of sensations
• Reduced or absent lower extremity reflexes

Requires urgent hospital admission

Question 17

Pelvic Injuries

Answer 17

Question 18

Pelvic Causes of Injury

Answer 18

• Direct violence – High energy transfer, crush injury
• Indirect violence – Fall from a height
• Muscular violence

Risk Factors:

• Advancing age
• Degenerative bone disease
• Radiotherapy

Question 19

Classification of Injury of Pelvic

Answer 19

Question 20

Pelvic #Complications

Answer 20

Damage to:

• Major blood vessels
• Nerves
• Organs:

‒Internal organs of reproduction

‒Bladder

Urethra

Question 21

Pelvic Fracture

Answer 21

• Potentially a life threatening injury
• 20% Polytrauma have Pelvic Fractures
• Death - 10% stable #. Up to 50% Unstable #
• Major internal haemorrhage with high risk of morbidity
• Requires stabilisation before transportation

Question 22

Pelvic Assessment

Answer 22

• <c> ABCD</c>
• Consider Mechanism of Injury (MOI)
• Severe pain from the back of the pelvis
• Inability to stand
• Rigidity of abdomen
• Legs in an unnatural position
• Feeling of pelvic cavity lying “open” or “falling apart”
• Do not “spring” the pelvis
• Swelling
• Urge to urinate
• Haematuria

Question 23

Pelvic Management

Answer 23

• Control any catastrophic haemorrhage
• Ensure an open airway
• Administer high flow O2 to maintain SpO2 of 94-98%
• Relieve pain with Entonox
• Immobilise the pelvis as soon as is practicable and before moving
• Constantly reassure and observe the patient
• Provide a smooth journey to hospital
• Any patient with hypotension and potential pelvic injury is “Time Critical”

Question 24

Functions of a Pelvic Splint:

Answer 24

• To splint the bony pelvis thereby reducing haemorrhage from bone ends and possible venous disruption
• To reduce pain and movement during transfers
• To provide some integrity to the pelvis by providing stabilization until definitive treatment can be achieved

Question 25

Indications for Pelvic Splint use:

Answer 25

• Mechanically unstable pelvis.
• Suspected pelvic fracture.
• Used for pain control and reducing movement during transfers.