Neck and spinal trauma management

Question 1

what are the important components of early SCI management?

Answer 1

Airway management 
Fluid resucitation
Prevent hypothermia 
GCS
Re-assess

Question 2

What secondary assessments are required for a suspected SCI?

Answer 2

History
Heat to toe
asses for pressure area risks
Log roll

Question 3

What are the care objectives of the spinal injury CPG?

Answer 3

• To identify patients with suspected SCI and transfer them to the appropriate facility
• To protect and support the integrity of the spinal column where SCI is suspected or unstable vertebral injury cannot be excluded
• To avoid unnecessary immobilisation by clinically excluding patients without injury to the spinal column

Question 4

what is the intent of spinal immobilisation?

Answer 4

To support natural alignment of the spinal column and reduce or distribute forces placed on it.

Question 5

How should spinal immobilisation be achieved?

Answer 5

By using a range of techniques to achieve the goal that are modified dependent on the circumstance

Question 6

What should you do if a collar isn’t working?

Answer 6

it can be moved, adjusted, loosen or removed if there are no other options.

Question 7

What may impact on having the patient in a supine position?

Answer 7

Pain, vertebral disease, kyphosis, injuries or CCF)

Question 8

What should be done if a patient is able to be managed supine?

Answer 8

You may position the patient into a position of comfort.

Question 9

Can patients remine on immobilisation board for transport?

Answer 9

No they can only be used for extraction, the patient should be removed prior to transport.

Question 10

Can the head be independently restrained to the stretcher?

Answer 10

no in capital bold red letter

Question 11

What kinds of patients should be treated with a high index of suspicion for unstable SCI even at low impacts/MOI?

Answer 11

Older patients, those sth vertebral disease or previous spinal abnormalities

Question 12

What are some examples of spinal disease/abnormalities?

Answer 12

ankylosing spondylitis, spinal stenosis, spinal fusion, pervious c-spine injury and rhematoid arthristis

Question 13

Should paints with penetrating trauma be routinely immobilised?

Answer 13

No only if there is demonstrable neurological effect.

Question 14

What drugs should be considered for all awake spinally mobilised patients?

Answer 14

An antiemetic via the nausea and vomiting CPG

Question 15

if a attend has a neurological defect or change or blunt force trauma to the neck or head what should be done?

Answer 15

Cervical collar
- extricate on combo-carrier if necessary
Immobilise on vacuum mattress or stresser
TCG
if isolated SCI and BP<90 - normal saline 10ml/kg IV

Question 16

What do we asses under the modified nexus criteria?

Answer 16

Increased injury risk- age 65 or older, hx of bone/muscle weakness or disease

Difficult patient
- altered conscious, intoxication, significant distracting injury

Actual evidence of structural injury
- Midline pain/tenderness on palpation

neck range of motion
- pt unable to rotate neck 45 degrees let or right without pain

Question 17

What must be assessed in the neurological examination?

Answer 17

Motor function-
Arms- push pull grasp
Legs- push, plantar flex, pull/ dorsiflex leg raise

sensory function- reduced or no sensation
arms: palms/back of hands
Legs: lateral aspect of calcaneus
Suprasternal notch

Paitent reports numbness, tingling, burning or any other altered sensation in the body