EMS Update Spinal Motion Restriction Training

Transcription

1 EMS Update Spinal Motion Restriction Training

2 700-M11 Spinal Motion Restriction Spinal Motion Restriction, also called SMR Formally known as Spinal Immobilization or C-Spine Effective February 9, 2016 Treatment protocol is for all EMS Provider levels Students will learn: 1. Definitions of SMR 2. Spinal Injury Assessment 3. Treatment Flow Chart

3 SMR Definitions Full SMR or traditional spinal precautions consists of: 1. Properly sized rigid cervical collar 2. Long plastic radio translucent spine board 3. Web belt or strapping devices 4. Lateral head support device Modified SMR consists of: 1. At minimum, a properly sized rigid cervical collar 2. Gross movement or restriction of the spine

4 When to use Full SMR SMR will be applied to all patients that have or may have sustained a significant mechanism of injury and have an abnormal Spinal Injury Assessment SMR will be applied for all patients meeting Major Trauma Victim (MTV) criteria in Policy 605 Prehospital Trauma Triage Except for penetrating trauma to head, neck, or torso without neurological deficits, spinal deformities, priapism or secondary MOI

5 When to use Modified SMR Modified SMR may be applied when full SMR is not practical or is not best suited for the management of the patients special circumstances Modified SMR begins with manual cervical stabilization and is at minimum to include a rigid cervical collar Modified SMR may be applied for those patients that the provider has a less acute injury suspicion Modified SMR may be as simple as placing a collar and securing the patient to the gurney with seatbelts

6 When to Omit SMR SMR should be omitted for MTV patients with penetrating trauma to head, neck, or torso without neurological deficits, spinal deformities, priapism or secondary MOI Example: A victim with gunshot wound to the neck that falls down the stairs should have full SMR, Example: A victim with gunshot to the neck that falls to the floor may have SMR omitted SMR may be omitted if the patient is not a MTV, and has an unremarkable Spinal Injury Assessment

7 Spinal Injury Assessment (part 1) Always begin this assessment with manual cervical stabilization in place 1. Determine the patient is without a language barrier 2. Assess for any distracting injuries & alcohol or drug use 3. Determine if the patient is cooperative, alert & orientated 4. Palpate and visualize the entire vertebral spinal column for injury IF the above is Abnormal, apply SMR IF the above is Unremarkable, continue exam

8 Spinal Injury Assessment (part 2) Continue manual cervical stabilization 1. Assess for adequate CMS in all extremities 2. Assess for flexion and extension in both elbows & wrists 3. Assess finger adduction and abduction in both hands 4. Assess flexion and extension in both knees 5. Assess plantar flexion and dorsiflexion in both feet IF the above assessment is Abnormal, apply SMR IF the above assessment is Unremarkable, consider Modified SMR or omit SMR

9 Spinal Injury Assessment ABDUCTION is spreading the fingers away from the midline ADDUCTION is the movement to return fingers to the anatomical position

10 Spinal Injury Assessment PLANTAR FLEXION pointing the toes down DORSIFLEXION pulling the toes up

11 Treatment Flow Chart Potential for Spinal Injury Follow the treatment chart Remember to hold manual cervical stabilization throughout Perform initial assessment If unremarkable continue to Spinal Injury Assessment Decision point: Full SMR Modified SMR Omit SMR Manual C-Spine Language Barrier? Distracting Injuries? Alcohol or Drug Use? Cooperative, A&O? Palpate & Visualize? Unremarkable Assess CMS x4 Flexion & Extension of Elbows, Wrist, & Knees Adduction & Abduction of Hands Plantar Flexion & Dorsiflexion of feet Unremarkable Abnormal Apply SMR Abnormal Modify or Omit SMR