Spinal Cord Immobilization in Aquatic Environment

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Spinal Cord Immobilization in Aquatic Environment

  1. 1. SPINAL CORD INJURY IMMOBILIZATION IN THE AQUATIC ENVIRONMENT September 2007 Leonardo A. Manino EPSA President - Argentina ILS Full Member Chief Lifeguard Rosario. Argentina EMT-P SBV-PHTLS Instructor
  2. 2. Abstract <ul><li>Purpose: </li></ul><ul><li>How recognize and handle Spinal Cord Injury (“SCI”) situations in water </li></ul><ul><li>Conclusion: </li></ul><ul><li>Immobilization is not mandatory in every victim case </li></ul><ul><li>T here is no single method to be applied </li></ul><ul><li>Immobilization is not a priority when v ictims are unconscious or do not breath normally </li></ul>
  3. 3. SCI Affects the sensitivity and loss of movement below the level of the injury COMMON CAUSES: MOTOR VEHICLE CRASHES FALLS PENETRATING INJURIES SPORTS INJURIES 60% are diving related
  4. 4. SCI in water Toledo,Castilla La Mancha ,Spain:rivers/lakes have a high impact ( 5 %) Hospital Nacional de Paraplejicos Washington State US: lakes have a medium impact (0.5%) R. S Watson MD, Peter Cummings MD y cols. Periodicity of SCI depends on the characteristics of the environment: Rio de Janeiro: beaches have a very low incidence (0,009%) Szpilman, MD, Brewster, Lg.
  5. 5. IN WATER SCI SITUATIONS HIGH IMPACT TRAUMA: Head-first in shallow water and/or from hight structures Water SPORTS accidents Small plane crashes Fights in the water Victims in trouble for unknown reason
  6. 6. Gentility of Dr. Szpilman
  7. 9. SCI Mechanisms of injury VERTICAL COMPRESSION Projet Wipeout. Hoag Memorial Hospital Presbyterian N ewport B each , Ca . EUA. HYPERFLEXION
  8. 10. HYPEREXTENSION Projet Wipeout. Hoag Memorial Hospital Presbyterian Newport Beach, Ca . EUA SCI Mechanisms of injury ROTATIONAL INJURY
  9. 13. www.socorrismo.com
  10. 14. SCI : SINGS AND SYMPTOMS Pain on the head, neck or back . Loss of movement and sensitivity below the level of injury. Numbness, Pins and needles in legs or arms Lacerations and contusions in head or face. NOTE: the lack of neurologic deficit or the absence of sings and symptoms does not rule out a bony fracture or an unstable spine .
  11. 15. HANDLE A SCI VICTIM in water: CHECK THE LEVEL OF CONSCIOUSNES <ul><li>UNCONSCIOUS: </li></ul><ul><ul><li>Check breathing still in water; </li></ul></ul><ul><ul><li>Not breathing --- IN WATER BLS </li></ul></ul><ul><ul><li>CONSCIOUS </li></ul></ul><ul><ul><li>or breathing normally </li></ul></ul><ul><ul><li>In line manual inmobilization, </li></ul></ul><ul><ul><li>then full inmobilization in or out </li></ul></ul><ul><ul><li>of water </li></ul></ul>
  12. 16. 1-VICE GRIP 2-EXTENDED ARMS GRIP 3-BODY HUG SCI Immobilization techniques
  13. 17. VICE GRIP A- WATER ABOVE THE LG HIP D- POOLS AND OPEN WATER B- VICTIM IN PRONE POSITION C- SUMERGED VICTIMS
  14. 18. VICE GRIP 2.- CERVICAL COLLAR 3.- SPINAL BOARD 1.- MANUAL IN LINE INMOBILIZATION 4.- IN WATER FULL INMOBILIZATION
  15. 19. EXTENDED ARMS GRIP A- WATER BELOW THE LG`S HIP. D-POOL, OPEN WATER B- PRONE POSITION VICTIMS C. DEEP WATER
  16. 20. EXTENDED ARMS GRIP 1.- MANUAL IN LINE INMOBILIZATION 2.- CERVICAL COLLAR 3.- SPINAL BOARD 4.- IN WATER FULL INMOBILIZATION
  17. 21. BODY HUG A- IN OPEN WATER WITH SURF CONDITIONS WATER ABOVE LG HIP B- VICTIMS IN PRONE POSITION C. IN POOLS
  18. 22. BODY HUG Full Inmobilization out of water
  19. 23. 2.-There is no single method to be applied. The three techniques shall be handle. SUMMARY 1.- Not to authomatically immobilize the victim in the water but recognize the potential SCI. 3.- Unconscious victims or not breathing , the immobilization is not a priority but giving immediately place to BLS/ALS .  
  20. 24. Bibliography PRE HOSPITAL TRAUMA LIFE SUPPORT MANUAL 5th edition. National Association of EMTs (US) The Committee on Trauma of the American College of Surgeons. 2003 SPINAL INJURIES: IMMOBILIZATION AND EXTRACTION. Peter Wernicki, M.D., Peter Fenner, M.D., David Szpilman, M.D. Hand Book of drowning. 2003. AQUATIC CERVICAL SPINE INJURY(CSI) – How often do we have to worry ? Szpilman , MD, Brewster, Lg, Cruz Filho, MD – Cervical Spine Injuries among Submersion Victims , The Journal of TRAUMA R. S Watson MD y cols. Hospital Nacional de Parapléjicos from Toledo Health Service of Castilla-La Mancha – Spain www.diariomedico.com Projet Wipeout. Hoag Memorial Hospital Presbyterian N ewport B each , Ca . EUA. IN-WATER CERVICAL SPINE INJURY ALGORITHM . Szpilman - Manino . 2004
  21. 25. SPINAL CORD INJURY IMMOBILIZATION IN THE AQUATIC ENVIRONMENT by Leonardo A. Manino
  22. 26. NO Yes NO Yes IN-WATER CERVICAL SPINE INJURY ALGORITHM SUSPICIOUS OF CERVICAL SPINE INJURY? Start rescue without cervical spine immobilization. See In-water Basic Life Support algorithm . Evaluation by the Emergency Medical System - Advanced Life Support Ambulance – Transport to the Hospital VICTIM IS CONSCIOUS? NO Yes Place victim’s face out of water and check: The victim is breathing ? In Line Manual Immobilization At first without equipment Open airways and start 5 to 10 mouth-to-mouth ventilation s in place and rescue to a dry place while ventilate, without cervical immobilization Rescue the victim out of the water. Place the victim parallel to the waterline. Start Basic Life Support and Reassure cervical immobilization. Full cervical immobilization Use a back board when available to pull the victim out of water. SHALLOW WATER? (lifeguard can stand up) “VICE GRIP” technique NO Yes Above Lifeguard’s hip? “BODY HUG” technique “EXTENDED ARMS GRIP” technique Wait for further help (vessel) Use a rescue flotation device (tube) when available Yes NO Manino-Szpilman 2004
  23. 27. <ul><li>LEONARDO A. MANINO - EPSA PRESIDENT – CHIEF LIFEGUARD COSTANERA ROSARIO E.E.M. ARGENTINA – EMT-P - SBV INSTRUCTOR. Contacto: leomanino@yahoo.com.ar / rosario@epsa.org.ar </li></ul>THANKS FOR YOUR ATTENTION !!!!!

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