Spine and Limb Injury Flashcards
What can spine and limb injuries be for the casualty?
Life threatening and life changing.
What is the spine?
The spine is the protective covering to the spinal cord.
What is important about the spinal cord?
It provides the majority of sensation and movement for the body beneath the skull.
What can happen if the cervical spine is damaged?
Total paralysis can be caused.
Where should spinal injuries be assessed?
Each medical role.
What should be done if a spine injury is suspected?
Immobilise.
What can your clinical suspicion for spine injury come from?
Feel of back of the neck.
Tenderness.
MOI
What are the MOIs of spinal injury?
Blunt or penetrating.
What is a primary injury?
Injury caused by initial injury to vertebrae and/or ligaments and/or nerves.
What is secondary injury?
Injury to nerve vessels from ensuing oedema or latrogenic factors. (What we do to patient)
What is a complete and a incomplete injury?
No neurological function bellow injury, some function bellow injury.
What is the level of injury?
Where on the spine the injury effects. Taken from the highest myotome and dermatome level.
What is a dermatome?
An area of skin that is mainly supplied by a singal spinal nerve.
What nerve affects the area where your TRF are?
5th cervical nerve
What nerve affects where your belly button is?
10 Thoracic nerve
How many pair of nerves are there?
8 cervical 12 thoracic 5 Lumbar 5 sacral 1 coxygeal
What is a myotome?
A single muscle group that is supplied by a specific spinal nerve.
What nerve allows you to spread your fingers out?
Thoracic 1st
What happens if the nerves that control ventilation become paralysed?
Hypoventilation
What nerves innervate the diaphragm?
C3, 4 and 5
What nerves innervation the intercostal muscles?
The thoracic
What causes Neurogenic Shock and what does it result in?
Disruption of the sympathetic chain.
Results in vasodilation, hypotension, warm peripheries, bradycardia and poor thermoregulation.
What will a patient need if they cannot breath for themselves.
External ventilation.
What do sympathetic nerves supply?
Fight and flight.
What do the parasympathetic nerves supply?
Rest and digest.
What are the signs and symptoms of spinal injury?
Conscious-
Spinal pain
Weakness or paralysis
Numbness, tingling, altered sensation.
Any conscious level- Loss of bladder control Priapism. Difficulty breathing. Exaggerated reflexes.
What is priaprism?
A persistent erection without stimulation.
What do you do in CUF with spinal casualty?
Prioritise getting to safety.
What do you do in a semi permissive environment with a spinal casualty.
Bear it in mind but follow CABCDE.
Immobilise in blunt/blast injuries.
Remember there is no benefit to immobilisation with penetrating trauma.
What can you do when it is safe to do so?
Immobilise Safely move to neural allignment Maintain manual stabilisation. Apply semi-ridged collar. Log roll to scoop. Secure with blocks and tape. Maintain airway. (Jaw thrust) Consider ventilation Treat hypotension with fluids titrated to radial pulse. Monitor temperature, prevent hypothermia.
Who can clear a c-spine injury?
Doctors, Nurses and other healthcare professionals.
What requirements must be met to clear c-spine.
GCS 15 No intoxication No distracting injury No focal neurological deficit No posterior mid line tenderness
What are the most common injury seen in conflict?
Limb injuries often penetrating.
What limb injuries are common?
Traumatic amputations and limb-threatening injuries.
What is concerning about limb injuries?
Contaminated wounds and ensuing infection often lead to complications.
Limb injuries can be life threatening.
What are traumatic amputations often caused by?
Blast effect
Mines and IEDs
What are major vascular injuries often caused by?
Pentrating wounds.
Blunt trauma and fractures/dislocations.
What can fractures cause?
Major blood loss.
What happens with crush injuries.
Tissue ischaemia and possible cell death.
Myoglobin release, possibly leading to renal damage, acidosis, oedema, systemic inflammatory response, hyperkalaemia leading to arrhythmia.
How should you manage a crush injury?
Reduce time and give fluids to keep profusion to the kidneys.
Be careful fluids do not have potassium in them.
What is compartment syndrome?
A condition where pressure inside a fascial area becomes greater than capillary pressure preventing profusion.
What are the common compartments associated with compartment syndrome?
Forearm and lower leg.
What can raise pressure in compartments?
Oedema or blood from fractures or trauma.
How would you recognise compartment syndrome?
Limb is very painful, pain increases on passive stretch, swollen compartments, tense and tender, sensation may be altered. May be pale. Might have paralysis. Pulses may or may not be present.
How do you manage a limb injury
CUF:CAT Semi-permissive:CABCDE Look and feel, check peripheral pulses. Triage limb threatening wounds as T1 Clean and dress. Splint fractures and compartment syndrome. Analgesia and antibiotics.
