Chapter 32. Injuries to the Spine by Pearson Education, Inc. Upper Saddle River, New Jersey
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1 Chapter Injuries to the Spine
2 Topics Anatomy and physiology of the spine Spinal injuries Guidelines for immobilization Special considerations Enrichment
3 Introduction Injuries to the spine are among the most devastating that a patient may encounter from a traumatic event The long-term complications of paresis or paralysis can be a catastrophic event for some patients
4 Anatomy and Physiology of the Spine Parts of the nervous system Communication network of sensory and motor fibers to and from the brain
5 Anatomy and Physiology of the Spine Parts of the nervous system Spinal cord Motor tract Pain tract Light touch tract
6 Anatomy and Physiology of the Spine Parts of the skeletal system Provides the body with its framework Protects the brain and spinal cord
7 Common Mechanisms of Spine Injury Most common mechanisms are MVCs, GSWs and recreational activities Vertebral injury does not equal cord injury Likewise, a cord injury does not need to exist in conjunction with a vertebral injury Back to Directory
8 Common Mechanisms of Spine Injury Common mechanisms that cause vertebral injuries: Compression
9 Common Mechanisms of Spine Injury Common mechanisms that cause vertebral injuries: Flexion
10 Common Mechanisms of Spine Injury Common mechanisms that cause vertebral injuries: Extension
11 Common Mechanisms of Spine Injury Common mechanisms that cause vertebral injuries: Rotation and Lateral Bending
12 Common Mechanisms of Spine Injury Common mechanisms that cause vertebral injuries: Distraction
13 Common Mechanisms of Spine Injury Common mechanisms that cause vertebral injuries: Penetrations
14 Common Mechanisms of Spine Injury Assessment: spinal injuries Scene size-up Often the MOI upon arrival rather clearly demonstrates the suspicion for a spinal injury Take necessary BSI precautions Note the number of patients present Notify additional resources for disentanglement, extrication, or lift assisting early
15 Common Mechanisms of Spine Injury Assessment: spinal injuries Initial assessment Initiate manual stabilization of the cervical spine Evaluate the patient's mental status Assess for airway and breathing adequacy Evaluate the peripheral perfusion Determine the priority status of the patient
16 Common Mechanisms of Spine Injury Assessment: spinal injuries Focused history and physical exam Conduct either a rapid trauma assessment or focused physical exam Closely evaluate and document perfusion, motor, and sensory findings Vital signs should be obtained following the physical exam Use the SAMPLE history and OPQRST
17 Common Mechanisms of Spine Injury Assessment: spinal injuries During the focused history and physical exam Assess the PMS functions Assess for flexion
18 Common Mechanisms of Spine Injury Assessment: spinal injuries During the focused history and physical exam Assess the PMS functions Assess extension
19 Common Mechanisms of Spine Injury Assessment: spinal injuries During the focused history and physical exam Assess the PMS functions Assess finger abduction
20 Common Mechanisms of Spine Injury Assessment: spinal injuries During the focused history and physical exam Assess the PMS functions. Assess finger adduction
21 Common Mechanisms of Spine Injury Assessment: spinal injuries During the focused history and physical exam Assess the PMS functions Assess wrist and hand
22 Common Mechanisms of Spine Injury Assessment: spinal injuries During the focused history and physical exam Assess the PMS functions Assess plantar flexion
23 Common Mechanisms of Spine Injury Assessment: spinal injuries During the focused history and physical exam Assess the PMS functions Assess dorsiflexion
24 Common Mechanisms of Spine Injury Assessment: spinal injuries During the focused history and physical exam Assess the PMS functions Assess foot for pain response
25 Common Mechanisms of Spine Injury Assessment: spinal injuries During the focused history and physical exam Assess the PMS functions Assess hand for light touch
26 Common Mechanisms of Spine Injury Assessment: spinal injuries During the focused history and physical exam Assess the PMS functions Assess foot for light touch
27 Common Mechanisms of Spine Injury Assessment: spinal injuries During the focused history and physical exam Assess the PMS functions Assess flexion of great toe
28 Common Mechanisms of Spine Injury Assessment: spinal injuries During the focused history and physical exam As mentioned earlier, baseline vitals may also demonstrate indicative changes secondary to a spinal injury
29 Common Mechanisms of Spine Injury Assessment: spinal injuries Focused History and Physical Exam
30 Common Mechanisms of Spine Injury Assessment: spinal injuries Focused history and physical exam Guide to interpretation of findings
31 Common Mechanisms of Spine Injury Assessment: spinal injuries Focused history and physical exam Guide to interpretation of findings
32 Common Mechanisms of Spine Injury Assessment: spinal injuries Focused history and physical exam Guide to interpretation of findings
33 Common Mechanisms of Spine Injury Assessment: spinal injuries Focused history and physical exam Guide to interpretation of findings
34 Common Mechanisms of Spine Injury Assessment: spinal injuries Focused history and physical exam Incomplete spinal cord injury
35 Common Mechanisms of Spine Injury Emergency medical care: spinal injuries When in doubt, immobilize the patient Take necessary BSI precautions Establish manual inline immobilization Click here to view a video on the immobilization of a supine patient. Back to Directory
36 Common Mechanisms of Spine Injury Emergency medical care: spinal injuries Open and maintain the airway Assure breathing and oxygenation Assess the pulse, motor function, and sensation in all extremities Immobilize the patient to a long backboard Once immobilized, reassess PMS functions Provide any other specific treatment as needed Transport to the hospital
37 Common Mechanisms of Spine Injury Assessment: spinal injuries Detailed physical exam and ongoing assessment Perform a detailed physical exam en route if time and the patient condition warrant Repeat the ongoing assessment every 5 minutes with an unstable patient or any patient that demonstrates PMS deficits
38 Guidelines for Immobilization Immobilization tools Cervical Spine Immobilization Collars (CSIC)
39 Guidelines for Immobilization Immobilization tools Sizing a cervical immobilization collar Measure for proper collar size
40 Guidelines for Immobilization Immobilization tools Sizing a cervical immobilization collar Select the proper collar
41 Guidelines for Immobilization Immobilization tools Sizing a Cervical Immobilization Collar Assemble and preform the collar
42 Guidelines for Immobilization Immobilization tools Applying a Cervical Spine Immobilization Collar to a sitting patient
43 Guidelines for Immobilization Immobilization yools Applying a Cervical Spine Immobilization Collar to a sitting patient
44 Guidelines for Immobilization Immobilization tools Applying a Cervical Spine Immobilization Collar to a sitting patient
45 Guidelines for Immobilization Immobilization tools Applying a Cervical Spine Immobilization Collar to a lying patient
46 Guidelines for Immobilization Immobilization tools Applying a Cervical Spine Immobilization Collar to a lying patient
47 Guidelines for Immobilization Immobilization tools Applying a Cervical Spine Immobilization Collar to a lying patient insert 34-13c
48 Guidelines for Immobilization Immobilization tools Applying a Cervical Spine Immobilization Collar to a lying patient insert 34-13d
49 Guidelines for Immobilization Immobilization tools
50 Guidelines for Immobilization Immobilization tools Immobilizing a supine or prone patient with a full body immobilization device
51 Guidelines for Immobilization Immobilization tools Immobilizing a supine or prone patient with a full body immobilization device
52 Guidelines for Immobilization Immobilization tools Immobilizing a supine or prone patient with a full body immobilization device
53 Guidelines for Immobilization Immobilization tools Immobilizing a supine or prone patient with a full body immobilization device
54 Guidelines for Immobilization Immobilization tools Immobilizing a supine or prone patient with a full body immobilization device
55 Guidelines for Immobilization Immobilization tools Immobilizing a supine or prone patient with a full body immobilization device
56 Guidelines for Immobilization Immobilization tools Immobilizing a supine or prone patient with a full body immobilization device
57 Guidelines for Immobilization Immobilization tools Immobilizing a supine or prone patient with a full body immobilization device
58 Guidelines for Immobilization Immobilization tools Three-person logroll and immobilization
59 Guidelines for Immobilization Immobilization tools Two-person logroll and immobilization
60 Guidelines for Immobilization Immobilization tools Immobilization of a standing patient
61 Guidelines for Immobilization Immobilization tools Immobilization of a standing patient
62 Guidelines for Immobilization Immobilization tools Immobilization of a standing patient
63 Guidelines for Immobilization Immobilization tools Immobilization of a standing patient
64 Guidelines for Immobilization Immobilization tools Immobilization of a standing patient, 2 EMTs
65 Guidelines for Immobilization Immobilization tools Short spinal immobilization devices
66 Guidelines for Immobilization Immobilization tools Short spinal immobilization devices
67 Guidelines for Immobilization Immobilization tools Short spinal immobilization devices
68 Guidelines for Immobilization Immobilization tools Short spinal immobilization devices
69 Guidelines for Immobilization Immobilization tools Short spinal immobilization devices
70 Guidelines for Immobilization Immobilization tools Short spinal immobilization devices
71 Guidelines for Immobilization Immobilization tools Short spinal immobilization devices
72 Guidelines for Immobilization Immobilization tools Short spinal immobilization devices
73 Guidelines for Immobilization Immobilization tools Rapid extrication Rapid extrication is a process by which you remove a patient from a car rapidly Because this technique does not provide the same degree of cervical immobilization, it should only be performed under specific circumstances
74 Guidelines for Immobilization Immobilization tools Rapid extrication
75 Guidelines for Immobilization Immobilization tools Rapid extrication
76 Guidelines for Immobilization Immobilization tools Rapid extrication
77 Guidelines for Immobilization Immobilization tools Rapid extrication
78 Guidelines for Immobilization Immobilization tools Rapid extrication
79 Special Considerations Helmets Generally, helmets can be left in place providing that they fit well, there are no critical findings on the patient Know when to leave the helmet on, and when it is best to remove it
80 Special Considerations Immobilizing patient with football helmet
81 Special Considerations Infants and children Use appropriate sized equipment If the cervical collar fails to fit properly, use a rolled towel taped down and continue immobilization of the pediatric patient
82 Special Considerations Infants and children Immobilization with a car seat
83 Special Considerations Infants and children Removing a pediatric from a car seat
84 Special Considerations Infants and children Removing a pediatric from a car seat
85 Special Considerations Infants and children Removing a pediatric from a car seat
86 Special Considerations Infants and children Removing a pediatric from a car seat
87 Special Considerations Infants and children Removing a pediatric from a car seat
88 Enrichment Neurogenic shock A severe cord injury can cut the sympathetic nervous system. The result is a lack of sympathetic tone with resultant vasodilation, and an inability of the heart to increase its rate. This may create a state of tissue hypoperfusion.
89 Fill in the certificate on the next slide and print it. Attach a copy of it to the Practice report and file it in the training mailbox.
90 Certificate of Completion Name Has completed a ¾ hour self study class on Spinal Injuries and Immobilization Completed on, 20. Signature * By signing above, I attest that I have completed the Spinal Injuries and Immobilization Class.
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