Module 20- Spinal Injuries Management

Question 1

Management of spinal injuries

Answer 1

• Recognize the potential for actual injury

Question 2

Appropriate immobilization

Answer 2

Remember potential pressure points (lumbosacrum and occiput)

Question 3

What is the primary goal?

Answer 3

• To prevent further injuries
  
  • Rigid cervical collars can contribute to elevation of ICP
  • Prolonged time on scene can be an issue (time goal is 10 mins or less)

Question 4

Cervical spine clearance:

Answer 4

• Local protocols should be known
• Definitive protocol not yet established

Question 5

Factors to consider for clearance:

Answer 5

• Patient has no neurological deficits, no motor/sensory deficits
• Patient not on meds, drugs, or alcohol
• No distracting injuries to patient
• Patient has no pain or tenderness upon movement or palpation

Question 6

Supine Immobilization

Answer 6

• Backboard (best to move from ground with a four person log roll)
• May use scoop stretcher or slide board
• Ensure head, torso, and legs move as a unit
• Toddlers can be immobilized in car seat, unless need to be supine
• PPE, manual in-line stabilization

Question 7

Who directs patient movement?

Answer 7

• Paramedic at the head

Question 8

How to hold c-spine?

Answer 8

• Support lower jaw with index and long fingers, head with palms
• Don’t remove hands until pt is secured
• Apply properly sized cervical collar

Question 9

What should you secure when putting pt onto a board?

Answer 9

• Secure upper torso
• Secure pelvis and upper legs
• Reassess distal PMS function in each extremity
• Secure arms if pt can’t control

Question 10

What are some spinal splinting considerarions?

Answer 10

• Pt’s should not be forced into a neutral or in-line position, if they have muscle spasms of neck; increased pain with movement, numbness, tingling, or weakening (splint in position found)
• Pt should be maintained in a neutral position unless pain or resistance to movement
• Padding under the occiput is recommended in adults only

Question 11

What do pediatrics need under shoulders?

Answer 11

• Need padding under shoulders due to larger head to body size

Question 12

Patients in the Prone/ Side-Lying Position

Answer 12

• Log roll to supine position
• Manually stabilize head and neck in position found (crossed hand position)
• Immobilize as described for supine patient
• Rescuer at head calls the movement

Question 13

Unconscious Patients

Answer 13

• Maintain position in which patient was found unless respiration is compromised
• If in resp distress, bring axial alignment with gentle traction
• Halt the motion if any signs of distress

Question 14

Seated Patients

Answer 14

• Manually stabilize head & neck
• Place collar
• Use vest-type extrication or rapid ex (depending on pt & enviornment)

Question 15

When do we most commonly use rapid ex?

Answer 15

• Vehicle or scene is unsafe
• Pt can’t properly be assessed

Question 16

What are some Rapid Extrication concerns?

Answer 16

• Delay that would occur from application of vest or half board is unacceptable
• Manual support carries a greater risk of spinal movement occurring (only use if move is urgent)

Question 17

Patients wearing helmets

Answer 17

• Often found in motor vehicle and sports-related accidents
• Greatly reduce the incidence and severity of brain injury
• Most helmets consist of an inner foam layer surrounded by a durable plastic shell

Question 18

Why do we need to remove a helmet?

Answer 18

• Interfere with airway management
• Interfere with spinal immobilization
• Helmet removal will cause some spinal motion

Question 19

Pharmacology of SCI

Answer 19

• Short-acting reversible sedatives
• Pain medications
• Steroids to reduce inflammation remains controversial
  
  • The National Acute Spinal Cord Injury Study II and III in the United States supports the use of methylprednisolone in acute penetrating SCI
• The use of steroids in the acute phase of SCI is not routinely practiced in Canada

Question 20

Methylprednisolone

Answer 20

Acute nonpenetrating SCI less than 3 hrs since injury- 30 mg/kg bolus over 15 mins followed by infusion 45 mins after bolus of 5.4 mg/kg/hr over next 23 hrs for 48 hrs

Question 21

What are some complications of SCI?

Answer 21

• Cause of high morbidity and mortality
• High financial costs
• Potential of respiratory aspiration and arrest, impairment of coughing and deep breathing, atelectasis, and pneumonia
• Loss of parasympathetic innervation and occurrence of autonomic dysreflexia (autonomic hyperreflexia)
• Nontraumatic spinal conditions (lower back pain)

Question 22

What are some s/s of Autonomic Dysreflexia?

Answer 22

• Hypertension
• Headache
• Nasal congestion
• Dilation of the pupils
• Anxiety
• Bradycardia
• Rebound hypotension
• Flushing and sweating above SCI
• Erect hair above SCI
• Chills without fever
• Bronchospasm
• Seizures, stroke, and death

Question 23

Nontraumatic Spinal Conditions

Answer 23

• Upright posture brings load to lumbar spine, especially at L4-L5 level
• Older humanas are susceptible to degenerative disease of the spine
• Occupations can cause spinal injury due to repetitive lifting and vibrations
• Most low back pain is idiopathic, which makes diagnosis hard
• Osteoporosis and spinal degeneration are common in the elderly
• Spinal tumors
• Degenerative disc disease
• Disc herniations