Spinal injuries Flashcards
According to ICoNiF algorithm, which one of the following would not be considered a dangerous mechanism in a cervical spine injury?
Considered dangerous:
Evidence of a significant distracting injury
Unconsciousness on the field of play
Thoracic injury with a pain score of > 7/10
Axial load collision
Not considered dangerous: Falling from the players height
What does ICoNiF stand for?
Imobilisation and cervical spine or not in football
What are the two best extrication methods for a player with a suspected pelvic ring fracture?
- After application of pelvic binder, with full team reform a 15 degree tilt onto a split device. Then apply full body straps and triple immobilisation.
- After application of pelvic binder, with full team directly scoop the player onto a split device. Then apply full body straps and triple immobilisation
High risk factors in ICoNiF:
(Which three of the below are considered to be low-risk factors in ICoNiF that, if present, allow the medic to proceed with their assessment?)
High risk factors;
- Seizure
- GCS < 15
- Axial load collision
- Altered level of consciousness
- Ataxia
- Thoracic injury with a pain score > 7/10
- A fall from two times the players height
Low risk factors:
- An absence of midline c-spine tenderness
- No immediate onset of pain
- The player being ambulatory after the injury
During a football event, a player is being extricated from the field of play.
Which one of the following statements is correct when referencing extrication and MILS?
Manual in-line stabilisation should be continued if you are unsure as to the stability of the straps and head blocks
Can you identify the five low-risk criteria used by the Nexus rule?
NEXUS definition: The NEXUS Criteria for C-spine Imaging clears patients from cervical spine fracture clinically, without imaging.
No midline tenderness
No focal neurological deficit
Normal alertness (A on AVPU)
No intoxication
No painful distracting injury
In relation to spinal injuries: with or without dangerous mechanism of injury, what are concerning signs and symptoms?
Paralysis
Paraesthesia
Ataxia
<15 GCS
Whilst attending a full-contact training session, you are called over to a player who has had an unwitnessed collapse. On approach, you find he is unresponsive, lying in the foetal position and is making occasional snoring noises.
What is your next immediate action?
Apply MILS. Perform a mini ABC check and make your decision on how to proceed based upon your findings
In the sport of contact football, there is always a level of concern for potential injuries to occur at the cervical spine. However,in some situations, a decision to rule out or not the need for immobilisation is taken.
What are the most appropriate process steps in this decision being made?
Step one: MILS in situ
Step two: Ensure A on AVPU/GCS 15
Step three: Ensure no significant MOI or concerning signs and symptoms
Step four: Palpate c-spine midline to T2 to check for pain/step deformity
Step five: Check sensory/motor function in upper limbs
Step six: rotating neck 45 degrees and report any pain or sensation
Step seven: If all process steps are OK, no triple immobilisation is required
The below is an abstract taken from the ‘immobilise or not the c-spine in football ICoNiF’ algorithm in your manual.
Use the drop-down lists to fill in the blanks
In the instance of any high-risk factor existing or a sign or symptom manifesting you should blank
If any low-risk factor manifests which allows safe assessment of range of movement you should blank
If the player is able to actively rotate their neck 45 degrees you should blank
In the instance where no mechanism of injury exists, no signs, symptoms or high-risk factors exist you should blank
In the instance of any high-risk factor existing or a sign or symptom manifesting you should: immobilise
If any low-risk factor manifests which allows safe assessment of range of movement you should: Proceed
If the player is able to actively rotate their neck 45 degrees you should: not immobilise
In the instance where no mechanism of injury exists, no signs, symptoms or high-risk factors exist you
should: not immobilise
Remember: for this algorithm to come into play, the player >16 years of age, is A on AVPU on the field of play / GCS 15 in the medical room, orientated and already is or trying to sit/walk/move.
Define triple immobilisation:
‘Triple immobilisation’ is the standard by which any cervical spine injury is said to be secure. This consists of (i) a semi-rigid collar, (ii) foam blocks applied to the side of the head and (iii) 2 straps (forehead and chin) to secure the head between the blocks. Improvised triple-immobilisation is considered unacceptable in professional football.
You are the medical cover at a game in which one of your players is hit with a head-height tackle. On approach, she is sitting up. When questioned, she responds to voice, saying she is fine and wants to get up and continue the game. However, even in the sitting position, she is uncoordinated, appears confused and is unable to make eye contact with you.
What is your next immediate action?
Take MILS and, with your team, gently lower her to the ground and extricate with full spinal immobilisation
You are at an away fixture and are called onto the pitch by the referee to your defender who has collided with the base of the goalpost after sliding in for a tackle. This is one of the first matches you have attended as a medic, but luckily, the opposing team’s doctor enters the field of play behind you. When you get to your player, he is supine and unresponsive. You apply MILS, look inside his airway and decide to apply a jaw-thrust that opens his airway. The opposition doctor sizes an oropharyngeal airway and tries to insert it but, due to a gag reflex, your player will not tolerate the airway. The doctor then attempts to insert a smaller sized airway and again is unsuccessful.
What should you do?
Point out assertively that the player is not tolerating an oropharyngeal airway but may tolerate a correctly sized nasopharyngeal airway and ask the doctor to insert this
If a player presented with an altered level of consciousness and you had clinical suspicion of a spinal injury, what would confirm your suspicion? 4 aspects
Flaccid paralysis below the level of impact
Urinary incontinence
Diaphragmatic breathing
Priapism
You suspect your striker has a neck injury following a flagged mechanism of injury in a competitive game. Following a full assessment (where the player is V on AVPU), you move onto extrication. You begin to immobilise the cervical spine but when the player observes the semi-rigid cervical collar they are insistent they will not tolerate it and become agitated.
What is your next immediate action?
Leave the player with no collar in situ and remain in MILS throughout the extrication until blocks and straps are firmly in situ (for best practice MILS is also maintained)
