Spinal Trauma

Learning Objectives
At the end of the presentation the student will be able to
Describe the assessment finding associated with head and spinal injuries.
Identify the need for rapid transportation of the patient withheld and spinal injuries.
Describe the assessment finding associated with traumatic spinal injuries.
Differentiate between spinal injuries based upon the assessment and the history.
Formulate a field impression based upon the assessment of spinals injuries.
Develop a patient management plan based upon the field impression.
Describe the management of the traumatic spinal injury patient.

Introduction
1.25 Million to care for a single victim
Overall life span
15,000 - 20,000 SCI /year
Higher in Men 16 - 30 yrs old
Causes
MVA 2.1 million per yr (48%)
Falls (21%)
Penetrating Injuries (15%)
Sports injuries (14%)

Morbidity and mortality
40% of trauma patient with neuro deficit will have temporary or permanent SCI
25% of SCI may be caused by improper handling

Anatomy review
Cervical - 7
Thoracic - 12
Lumbar - 5
Sacral - 5
Coccyx - 4 (1)

Vertebral Body
Transverse process
Spinous process
Intervertebral foramen
Intervertebral Disk

Spinal Nerves

Assessment
Positive MOI
High speed MVA
Falls > three x height
Stabbing
GSW
Sports injuries
????

Critical Criteria
Initial management based upon MIO
Positive MIO - immobilize
Uncertain MIO - further assessment

Milwaukee County Protocol

Asses for spinal pain
Any related spinal pain
Any pain with movement
Signs
Symptoms
Palpate over each spinous process
Sensory function
Motor function

Management for Spinal Injuries
Prevent further injury
Treat as long bone with joint at either end
15% of secondary injuries are preventable
ALWAYS complete spine immobilization
Reassess after immobilization

Immobilization
Cervical immobilization
KED
Long board
Padding
Straps
Cervical immobilization Device

Helmeted Patients
Indications for leaving a hemet in place.
Indications for helmet removal

Case
You are dispatched to a single vehicle MVA.
Upon arrival you find a unconscious not breathing patient laying across the front seat of the vehicle.
What are your priorities?
How do you achieve them?

The patient is rapidly extricated and placed on a long board with in-line stabilization.
The space between the board and the head was approximately 6”
What would you do?

He is placed in the ambulance and ventilation is attempted without success.
What would you do now??

Using a laryngoscope you observe a “Breath saver” lodged on the vocal cords.
It is removed.
Would to intubate this patient??

The patient is intubated and two large bore IV are placed.
Vital signs
Resp - ventilated
Pulse - 110
BP - 140/76
AVPU - unresponsive
Pupils - sluggish
Patient is transported without delay.

Upon arrival to the Level I Trauma Center the patients condition is unchanged.
X-ray
Labs
ET placement is confirmed with X-ray

The patient is admitted to TLC
His cervical spine is repaired
His thoracic spine is repaired
His lumbar spine is repaired
His closed head injury/skull fx is treated with observation
He recovers full in approximately 6 weeks
No neurological deficits

Spinal Trauma

by Jim Keiken on Feb 21, 2009

Accessibility

Categories

Upload Details

Usage Rights

1 Embed 15

Statistics

Spinal Trauma Presentation Transcript