Spinal Injury
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Stephen Schutts, Master Sergeant, WA ANG

Stephen Schutts, Master Sergeant, WA ANG
National Registry Emergency Medical Technician - Paramedic

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Spinal Injury Spinal Injury Presentation Transcript

  • Assessment of Spinal Injury Stephen Schutts, Master Sergeant, WA ANG National Registry Emergency Medical Technician - Paramedic
  • Objectives
    • Identify the anatomical levels of the spine.
    • Understand the function of the spinal cord/column.
    • View Types and Mechanisms of injury that can cause spine injury.
    • Discuss the difference between Spinal Column Injury vs Spinal Cord Injury.
  • Objectives
    • Overview of Spinal Regions and Injuries
    • Step by step view of the EMS Spinal Immobilization Assessment Protocol
    • Discuss Common Treatment/Management Mistakes
  • Introduction
    • Spinal injuries are devastating
    • Improper management can have horrible and permanent results
    • Appropriate use of spinal immobilization can mean the difference between a patient who fully recovers and one who must spent the rest of his/her life paralyzed
  • Mechanism based assessment (the current method)
    • Low-speed fender bender
    • An elderly man trips over a lamp cord and falls
    • When in doubt back board ‘em
    • Are all 8 patients assumed to have spinal injuries?
    • Does this man have a spinal injury? Do all such falls cause spinal injuries?
    • Not necessarily, apply EMS Spinal Immobilization.
  • Anatomy & Physiology- General Structure & Function
    • Spinal Column
    • Made up of 26 vertebrae stacked on top of one another
    • Divided into 5 areas; cervical, thoracic, lumbar, sacral, and coccyx
  •  
  • Anatomy & Physiology-“Long Bone”
    • Think of the Spinal Column as on “Long Bone” with “Joints” at each end
      • The Cervical spine makes up one “joint”
      • The Hip makes up the other
      • 8
  • Anatomy & Physiology- Cervical Spine (7)
    • “ Joint” at the superior end of the spinal “Long Bone”
    • Very flexible
      • Allows flexion, extension, and rotation of the head
    • The head acts as a weighted lever during acceleration/ deceleration
    • Common site of spinal injuries
  •  
  • C-1 “Atlas” C-2 “Axis”
    • C-1 supports the full weight of the head
    • C-1 and C-2 allow head rotation and fine flexion and extension
    • 11
  • Anatomy & Physiology- Thoracic Spine (12)
    • Much less flexible than C-Spine
      • Stabilized by rib cage (especially down to T-10)
    • Spinal canal narrow through T-Spine
      • Spinal cord tightly fitted into narrow space
      • Spinal cord ends about T-12 or L-1
  •  
  • Anatomy & Physiology- Lumbosacral Spine
    • 5 Lumbar vertebrae plus sacrum and coccyx
    • More flexible than T-spine
    • More room in spinal canal
    • Spinal cord ends about T-12 or L-1
      • flexible nerve roots (Cauda equina) flow through LS spine
  •  
  • Anatomy & Physiology- Spinal Cord
    • Bundles of nerve fibers originating in the brain
    • Bundles or tracts travel in right and left pairs
    • Spinal Tract pairs crossover midline at various specific levels
      • always in specific anatomical areas
      • understanding of the structure of these tracts helps in assessing spinal cord injuries
  •  
  • Mechanism of Injury
    • Physical manner and forces involved in producing injuries or potential injuries
    • Valuable tool in determining if the a particular set of circumstances could have caused a spinal injury
    • Mechanisms likely to produce spinal injuries occur in MVAs, falls, violence, and sports (including diving accidents)
  • Hyperflexion
  • Hyperextension
  • Hyperotation
  • Axial Loading
  • Axial Distraction
  • Sudden/Extreme Lateral Bending
    • Excessive/abnormal lateral movement of the spine
    • Can affect any portion of the spine
    • Example: T-bone MVAs
  • Spinal Column Injury
    • Bony spinal injuries may or may not be associated with spinal cord injury
    • These bony injuries include:
      • Compression fractures of the vertebrae
      • Comminuted fractures of the vertebrae
      • Subluxation (partial dislocation) of the vertebrae
    • Other injuries may include:
      • Sprains- over-stretching or tearing of ligaments
      • Strains- over-stretching or tearing of the muscles
  • Spinal Cord Injury
    • Cutting, compression, or stretching of the spinal cord
    • Causing loss of distal function, sensation, or motion
    • Caused by:
      • Unstable or sharp bony fragments pushing on the cord, or
      • Pressure from bone fragments or swelling that interrupts the blood supply to the cord causing ischemia
  • Primary Spinal Cord Injury
    • Immediate and irreversible loss of sensation and motion
    • Cutting, compression, or stretching of the spinal cord
    • Occurs at the time of impact/injury
  • Secondary Spinal Cord Injury
    • Injury Delayed
    • Occurs later due to swelling, ischemia, or movement of sharp or unstable bone fragments
    • May be avoided if spine immobilized during extrication, packaging, treatment, and transport
  • Incomplete Spinal Cord Injury
    • Complete injury to specific spinal tracts with reduced function distally
    • Other tracts continue to function normally with distal function intact
  • Spinal Region Overview
    • Cervical Spine Injuries
    • Thoracic Spine Injuries
    • Lumbosacral Spine Injuries
    • Spinal Injury Summary
  • Cervical Spine Injuries
    • C-spine very flexible
    • Most frequently injured area of spine
    • Most injuries at C-5/C-6 level
  • Thoracic Spine Injuries
    • T-spine less flexible
    • Narrow spinal canal
    • Cord injury occurs with minimal displacement
    • Common mechanisms
    • Any cord damage usually complete at this level
    • Most T-spine injuries occur at T-9/T-10
  • Lumbosacral Spine Injuries
    • LS spine flexible nerve roots in roomy spinal canal
    • May have bony injury w/o cord or nerve root damage
    • Secondary injury still possible
    • Neurological injury rare w/ isolated sacral injuries
  • Assessment Overview
    • Decision to apply spinal immobilization in past based was solely on mechanism of injury
    • Utilize EMS Spinal Immobilization Algorithm to determine when spinal immobilization is NOT needed
  • Spinal Immobilization Algorithm
    • Patient Mentation :
    • Decreased Level of Consciousness?
    • No Yes ----------------------------Immobilize
    • ETOH/Drug Impairment?
    • No Yes ----------------------------Immobilize
    • Subjective Assessment :
    • Cervical/Thoracic/Lumbar Spinal pain?
    • No Yes ----------------------------Immobilize
    • Numbness/Tingling/Burning/Weakness?
    • No Yes -----------------------------Immobilize
    • Objective Assessment:
    • Cervical/Thoracic/Lumbar Deformity or Tenderness?
    • No Yes -----------------------------Immobilize
    • Other Severe Injury?
    • No Yes -----------------------------Immobilize
    • Other Severe Injury?
    • No Yes -----------------------------Immobilize
    • Pain w/Cervical Range of Motion?
    • No Yes -----------------------------Immobilize
    • MAY TREAT/TRANSPORT WITHOUT SPINAL PRECAUTIONS
  • Principles of Treatment
    • Protect spinal cord from secondary injury
    • We have little or no effect on primary injury
    • Focus on prevention of secondary injury
  • Complete Spinal Immobilization
    • Must act as if whole spine unstable
    • Immobilize entire spine
    • To do this we must immobilize the head, neck, shoulders/chest, and pelvis /hips
  • Common Treatment/Management Mistakes
    • Improperly sized C-Collar
    • Spine not supported due to improper positioning on backboard
    • Inadequate strapping allows excessive movement
    • Movement possible due to little or no padding to shim the body
    • C-spine movement by inadequate or improperly applied head immobilization device
    • C-spine hyperextension due to improperly applied C-collar or head immobilization device
  • Common Treatment/Management Mistakes (cont.)
    • Readjusting torso straps after immobilization of the head, causing misalignment of the spine
    • Securing head to backboard prior to securing shoulders, torso, hips, and legs
  • Any Questions???