Unit 10a - Spinal and head Flashcards
spinal cord
- exit thru foramen magnum
- 2 pairs of spinal cords exit each vertebrae
- sever cord/nerve cause damage below injured area
- C3, 4, 5 control diaphragm (phrenic nerve)
spinal injuries
- simple as ligament sprain or muscle strain
- extreme such as death or paralysis
- 5mm displacement cause internal decapitation
- can cause bowel mvmnts/urination
C4: paralyzed below neck
C6: partial paralysis of hands/arm and all of lower body
T6: paralysis below chest
L1: paralysis below waist
dangerous MOIs
- unresponsive (unknown case)
- fall > 3.3ft / 5 stairs / 1m
- MVA (pedestrian, driver, passenger)
- helmet is damaged or came off
- blunt force to head or neck
- penetration to head or neck
- axial loading (ex: diving)
- electrocution
motions of injury
hyper extension
hyper flexion
hyper rotation
whiplash
axial loading
hyper flexion injuries
Force to occiput = rotate head fwd ; flexion follows
- stretch posterior structures
- fracture vertebral bodies
- spinal cord compressed
- discs herniated
hyper extension injuries
neck is forced into backward rotation
- spinous processes injured (palpate in PA)
- stretch anterior neck muscles
- compression of posterior structures
- can pinch off vertebral artery
axial load injuries
straightened neck (remove the natural lordosis)
- anterior muscles loose / contract
- posterior muscles extended
- Intervertebral disks shock absorbers but will curve to the front if over stressed (flexion)
Whiplash
symptoms caused by sudden, uncontrolled extension and flexion of the neck, often in an automobile accident
- lateral and rotary factors
- head should sit mid head rest or higher
rotation injuries
caused by turning the head beyond the normal range
- vertebral artery on opp side is stretched = decrease blood flow = change in LOR
- get back to neutral
s/s of head and neck injury
- change in LOR
- severe pain/pressure in head or spine
- persistent head ache
- N/T, total/partial paralysis
- skull deformity
- CSF/blood from nose or ears
- seizures
- bowel movement or urination
- bilateral periorbital ecchymosis
- periauricular ecchymosis
- nausea, vomit
- unequal pupils or not pearl
- respiratory and circulatory changes
- lose balance
canadian c-spine rule (CCR)
used to determine if SMR is needed
- high risk (older than 65, paresthesia in extremities, dangerous MOI), yes = SMR
- safe to assess ROM (sitting, ambulatory, deferred onset neck injury, no midline c spine pain), no = SMR
- actively rotate head (45 L and R), no = SMR
Simple rear-end MVC excludes
-pushed into oncoming traffic
-hit by bus/large truck
-rollover
-hit by high speed vehicle
when to apply CCR
- trauma patient
- patient is alert; GCS = 15
- stable vitals
- over 16 years old
- no acute paralysis
- no vertebral disease
- no previous c-spine injury
c-spine management (conscious)
no tingling, complete sensation, normal extremity strength, improving = walk them off field
- if in doubt, treat as severe and call EMS
c-spine management
- EAP in place and rehearsed
- recruit responsible personnel
neutral alignment contraindications:
- severe pain
- spasm
- neurochanges
- resistance or blockage
- airway/ventilation compromised
- malalignment of head and shoulders
spinal motion restriction
- only use rigid collars
- slight mvmnt is inevitable but try to minimize it all
- flexion reduced to 75-80 degrees
- too tight of collar = pressure on internal jugular vein
- too big = separation of c spine and skull
general head/neck care
minimize head and neck movement
maintain open airway
control bleeding
SMR if appropriate
monitor LOR, ABCs, vitals
maintain normal body temp
oxygen if needed
more medical care if needed
head to toe assessment (PA)
get npa or opa in (no contradictions)
spinal shock
an autodestructive process initiated w/in the spinal cord
- occur 30-60 min after trauma
- mechanical, biochemical , hemodynamic changes make ischemic or hypoxic state in cells
- neural tissue intact
- decrease LOR, necrosis, respiratory arrest
primary and secondary phases
spinal shock primary stage
- actual structural damage to neural tissues
- MOI: mechanical insult
- initial response is hemorrhage and swell of cap endo
- zone of injury: neural injury affect where MOI struck
- bradycardia, hypotension, lose reflexes
spinal shock secondary phase
- pathophysiological cascade of injury after primary phase
- progression of edema and autodestructive biochemical processes
decrease autoregulatory response of natural vasculature > significant decrease blood flow to spinal cord in 2 hours > ischemia, necrosis, permanent damage, death
