ATS - spine injuries

Emergency Medical Technician
27 – Spine Injuries
© 2014
• Trauma to the spine can
lead to permanent
disability and death
• Rapidly delivered and
appropriate care can
help minimize the
devastating effects of
these injuries
3

© 2014
• Always suspect the
possibility of spinal
injury whenever a
patient has suffered any
serious trauma,
especially any trauma
involving the:
– Head
– Neck
– Back
4

© 2014
1. Spine Injuries
2. Stabilizing the Spine
3. Assessing & Managing Spine Injuries
4. Helmet Removal

© 2014
• Spine injuries are
extremely serious
• Injury can impair
breathing and lead to
paralysis and death
• A wide variety of
trauma incidents can
cause spinal injury:
– Even when it seems
spinal injury is unlikely
7

© 2014
• Always suspect the
possibility of spinal
injury when serious
trauma involves the:
– Head
– Neck
– Back
• Anticipate injury to the
spine if MOI indicates
severe trauma:
– Chest
– Abdomen
– Pelvis
8

© 2014
• Spine injuries can be
classified as:
– Spinal column injuries
– Spinal cord injuries
• Some patients can have
both
9

© 2014
• Spinal column injuries
involve trauma to:
– Vertebral discs
– Ligaments
– Muscles
– Joint articulations
• Types of trauma can
include:
– Fractures
– Dislocations
– Muscle strains
– Disc injuries
10

© 2014
• If the injury involves
displaced fractures or
dislocations, the spinal
cord, discs and spinal
nerves can be severely
or permanently
damaged
11

© 2014
• Typically, the patient
will exhibit a significant
amount of pain and
tenderness at the level
of the injury
• Distal or proximal pain
can be present if the
superficial pain nerves
have been damaged or
lacerated
12

© 2014
• Spinal cord injuries
involve damage to the
nervous system tissue
that is inside the spinal
column:
– Injury can disrupt one
or more levels of motor
or sensory nerves
– Symptoms may be local
or distal to the injury
– Patients may not
experience immediate
pain
– Numbness or loss of
function, may be
delayed due to swelling
or bleeding
13

© 2014
• Assume some type of
spinal column injury,
spinal cord injury or both,
when the mechanism of
injury exerts great force
on the upper body
– There may or may not
be soft tissue damage
to the head, face or
neck

© 2014
• Compression of the
vertebrae
• Flexion - from
excessive forward
movement of the
head relative to the
torso
15

© 2014
• Extension - from
excessive backward
movement of the
torso
• Rotation - from
excessive rotatory
movement of the
spine
16

© 2014
• Lateral bending of
the head from side-
to-side relative to
the torso
• Distraction - from
stretching of the
spine relative to the
spinal column and
torso
17

© 2014
• Penetration injuries
to the spine from
any direction
18

© 2014
• Suspect and assess for
spinal injury with these
common mechanisms of
injury:
– Motor vehicle crashes
– Motorcycle crashes
– Pedestrian – vehicle
collisions
– Falls
– Blunt trauma
– Penetrating trauma to
the head, neck or torso
– Hangings
– Diving accidents
19

© 2014
• Injury to the spine can
damage the three major
nerve tracts that
control:
– Motor function
– Light touch
– Pain
• Loss of function in any
of these areas is a
critical finding:
– Indication that the
spine has been
compromised
20

© 2014
• Common signs and
symptoms of a spine
injury include:
– Tenderness in and
around the area of
injury
– Pain associated with
moving
– Pain independent of
movement or palpation
– Numbness, weakness
or tingling in the arms
or legs
21

© 2014
• Inability to feel or move
below the suspected
level of injury
• Loss of feeling or
movement in the upper
and/or lower
extremities
• Difficulty breathing or
shallow breathing
• Priapism
• Incontinence
22

© 2014
• Patients with a spinal
injury can develop
neurogenic shock:
– Caused by damage to
the sympathetic nerve
fibers
– Causes blood vessels to
dilate, causing
hypoperfusion
• The signs of neurogenic
shock differ from
hypovolemic shock
caused by fluid loss
23

© 2014
• Patient will have dry,
red or pink skin:
– Ability to constrict the
blood vessels distal to
the injury is lost
• The pulse will typically
be in the normal range
of 60 to 80 bpm or
slower due to a loss of
sympathetic nerve
stimulation
24

© 2014
• Vital signs are patient
specific
• Get as much patient
history as possible
• Patient may be unable
to maintain body
temperature due to the
vasodilation:
– Keep patient warm
25

© 2014
• Immediately place your
hands on the sides of
the patient’s head and
provide in-line manual
immobilization
• Direct patient to remain
still
• If immobilization is
indicated, continue to
provide stabilization
until patient is
completely immobilized
with a c-collar and
backboard
27

© 2014
• Asses ABCs
• Perform a rapid trauma
exam:
– After assessing head
and neck, apply a rigid
cervical collar:
 When applying c-collar
be careful to avoid any
flexion, extension,
rotation, traction or
compression relative to
the spine
28

© 2014
• If spinal injury is
suspected:
– Secure the patient to
the appropriate
immobilization device
– Follow your protocols
on when to use one
and which type of
device to apply
29

© 2014
• When using a
backboard:
– Carefully log roll the
patient onto his side
– Maintain alignment
and stabilization of
the head at all times
– Quickly check the
patient’s backside
for any other injuries
30

© 2014
– Position the
backboard
alongside the
back
– Log roll patient
on to the board
31

© 2014
• If needed:
– Apply padding in the
voids between the
patient’s torso and the
board
• Secure the straps
around the torso
• Evaluate and pad
behind the head, if
needed
• Take care not to tape
over the eyes or
eyebrows
32

© 2014
• Reassess motor,
sensory and circulatory
function in each
extremity
• Transfer the patient to a
stretcher, secure, and
load for transport
33

© 2014
• There may be
circumstances in which
you arrive on scene to
find a patient upright
and walking around
after a trauma incident
• The spine can be
compromised without
the patient realizing it,
and movement can
cause further, more
serious injury
34

© 2014
• To immobilize an upright
patient use the “rapid” or
”standing” takedown
35

© 2014
• First:
• Manually stabilize the
patient’s head from
behind
• Assessing for other
injuries
• Secure a rigid cervical
collar
36

© 2014
• Continue stabilization of
the head as other
rescuers position a long
spine board behind the
patient
• Centered the patient on
the board
• Two rescuers should:
– Reach one hand under
the patient’s armpit
and grasp the edge of
the board
37

© 2014
• With the other hand,
grab the patient’s arms
just above the elbow
• Reassure and explain
the process to the
patient
• Signal to begin tilting
the board backwards to
the ground
• The rescuers holding
the board should lower
it evenly and slowly
38

© 2014
• The rescuer at the head
will walk backward and
crouch to control
stabilization of the head
39

© 2014
• Once the patient is in
the supine position,
complete the
immobilization process
40

© 2014
• The Kendrick
Extrication Device
(KED) is an
immobilizing vest that
can be used to stabilize
the spine when a
patient is in a seat or
confined space
41

© 2014
• One rescuer will
manually stabilize the
head and neck
• Another rescuer will
perform a primary
assessment and rapid
trauma exam
• After examination of the
head and neck:
– Apply a rigid cervical
collar
– Continue to maintain
manual stabilization
42

© 2014
• Center the
immobilization vest
behind the patient
• Wrap the vest around the
torso and tuck it up into
the armpits
• Secure the torso straps
• Wrap the lower straps
around the patient’s legs
and secure
• Wrap one of the head
straps across the cervical
collar and secure it to the
vest
43

© 2014
• Secure head by wrapping
the remaining strap
across the forehead
• Confirm that the torso
straps do not interfere
with breathing
• Position the patient’s
hands
• Continue manual
stabilization as you pivot
the patient onto a long
backboard for transport
44

© 2014
• Assess and evaluate for
injuries based on
mechanism of injury
• Always follow
immobilization
protocols
• Provide manual
stabilization upon
contact when trauma is
suspected to the:
– Head
– Neck
– Spine
46

© 2014
• Assess and manage the
ABCs
• Use the jaw-thrust
maneuver to establish
and maintain an open
airway on an
unconscious patient
48

© 2014
• Gather information from
the scene or bystanders
• Perform a rapid
assessment:
– Apply a cervical collar
after assessing the
head and neck
• Observe for chest
movement:
– Paralysis of the chest
muscles can cause
respiratory arrest
49

© 2014
• Provide high-flow
oxygen:
– Prepare to ventilate
• Immobilize as
determined by protocols
• Prepare for transport
• Assess and monitor
vital signs closely
50

© 2014
• After primary
assessment, ask patient
about pain or
numbness:
– Specifically ask about
the neck and back
• When assessing for pain
avoid asking patient to
move the torso,
extremities or head to
detect a pain response
51

© 2014
• Look for injuries and
deformities
• An injury to the head or
an altered mental status
may make it difficult for
the patient to follow
commands or provide
accurate information
• Assess the patient’s
pulse, movement and
feeling in all extremities
52

© 2014
• Lightly touch the
patient’s fingers and toes
and ask if she is able to
feel it
• Determine whether she is
able to move her hands
or feet
• Gently hold her hands
and ask whether she can
squeeze
• If the patient
experiences pain,
immediately stop
performing that
assessment
53

© 2014
• If the patient is able to
move and sense touch,
the spinal cord is most
likely intact
• If the patient has only a
limited ability, there
may be pressure on the
spinal cord
• If the patient is not able
to move the hands or
feet and cannot feel
your touch, you must
suspect spinal injury
54

© 2014
• If the MOI suggests the
potential for spine or
spinal cord injury, but
the patient has
sensation or movement
in the arms and legs, it
still does not rule out
the possibility of spine
injury:
– Keep patient still even
if he insists he is fine
– Immobilize according
to local protocols
– Prepare for transport
55

© 2014
• While en route:
– Obtain and monitor
the vital signs closely
• Provide care for shock:
– A common
complication with
spinal injury
– Cover the patient to
preserve warmth
56

© 2014
• Leave the helmet in place if:
– The airway and breathing are NOT
compromised
– The helmet does not interfere assessing
and managing the airway
– The helmet fits well, and allows little or
no movement of the head inside
– Removal could risk further injury
– Immobilization can be done with the
helmet in place

© 2014
• Remove the helmet if you make the
following findings:
– The helmet interferes with assessment,
management and monitoring of the
airway and breathing
– The helmet is loose, allowing excessive
movement of the head inside the helmet
– The helmet interferes with spinal
immobilization
– The patient is in cardiac arrest

© 2014
• Remove glasses or
eyewear
• One EMT holds the
helmet in place with both
hands:
– Rest fingers on the
mandible to prevent
movement
• Loosen chin strap
• Place hands:
– One the angle of the jaw
– One at the base of the
skull
61

© 2014
• The first EMT pulls the
sides of the helmet to
provide clearance for
the ears:
– Then gently slip the
helmet halfway off
• The second EMT moves
one hand from the
corner of the jaw to
support the mandible
on both sides of the
chin:
62

© 2014
• Then reposition the
other hand higher under
the patient’s head to
protect it from falling
backwards
• The first EMT then
removes the helmet
• A cervical collar can
then be applied and the
patient immobilized if
required
63

© 2014
• You should always suspect the
possibility of spinal injury whenever a
patient has suffered any serious
trauma, especially any trauma
involving the head, neck and back
• It’s critical that you quickly recognize
and manage injuries to the spine
• Rapidly delivered and appropriate care
can help minimize the devastating
effects of these injuries

ATS - spine injuries

Recommended

Recommended

More Related Content

Similar to ATS - spine injuries

Similar to ATS - spine injuries (20)

More from VASS Yukon

More from VASS Yukon (20)

Recently uploaded

Recently uploaded (20)

ATS - spine injuries

Editor's Notes