chapter 22 spine injuries. © 2005 by thomson delmar learning,a part of the thomson corporation. all...

Chapter 22Spine Injuries

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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved

Overview

Types of Spinal Injuries Patient Presentation Assessment Management

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Types of Spinal Injuries

Without neurologic injury– Consist only of ligament or bone injuries– Patency of the spinal canal is not compromised– Sensitive spinal cord is not traumatized

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Moving the Patient

Watch this animation of how moving the patient with a spinal cord injury could cause further injury

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With neurologic injury– Certain signs and symptoms indicate

neurologic injury– These result from an interruption in the

normal message flow between the brain and the body

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Cervical– Injury has the most extensive consequences– Nearly 40% of cervical fractures have associated

spinal cord injury– Motor vehicle crashes account for a large number

of cervical spine injuries

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Thoracic– Not injured as often as more mobile areas– More likely to involve the spinal cord than

other areas– Often result from a direct blow to the back

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Lumbar– May not be as evident on examination as higher

cord injuries – Injuries usually caused by a flexion, extension, or

rotational mechanism

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Sacrococcygeal– Injury to sacrum usually results from a direct blow– Injury to coccyx usually results from a fall– Spinal cord does not extend to coccyx

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Patient Presentation

Mechanism of injury– First clue to the possibility of a spinal injury – Consider these suspect:

• Any blow to the spine• Any mechanism involving severe flexion, extension, or

rotation of the spine

– Large majority of injuries result from collisions, violence, or falls

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Mechanism of injury– Motor vehicle crash

• Often causes flexion/extension injuries• Force can cause motion beyond what is normally allowed• Intrusion of normal anatomy into the narrow spinal canal

causes cord injury

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Mechanism of injury– Falls

• Falls from any height can cause injury to the spine• Compression fractures are seen in patients who

experience a direct blow to a vertebra• Axial loading can cause spinal injuries

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Mechanism of injury– Firearms

• Create a penetrating injury that can damage the spinal cord or a vertebra

– Recreation• High school football results in 20–30 permanent spinal

cord injuries every year• Mechanism of injury varies with each situation

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Mechanism of injury– Associated injuries

• Suspect spinal injury when significant trauma is sustained by a body part close to the spine

• Head and face—assume cervical spine injury with trauma above clavicles

• Chest—assume thoracic spine injury• Abdomen—assume lumbar spine injury

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Signs and symptoms– Determine whether the patient has signs or

symptoms of possible spinal injury– Patient may not have symptoms of spinal injury

even though the mechanism is likely to cause one

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Limitations– Patients with certain conditions may not be able to

notice or describe symptoms of spinal injury • Intoxication • Altered mental status• Distracting injury

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Neck or back pain– Patient does not always feel pain in the

back or neck– If present, treat the patient as if a spinal

injury exists

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Stop and Review

Describe different types of spinal injuries.

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Neurologic abnormality– Respiratory failure

• Caused by damage to C3, C4, C5 • Diaphragm is necessary for effective breathing

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Neurologic abnormality– Neurogenic shock

• Vasodilation• Patient appears flushed• Heart rate remains normal• Hypotension

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Neurologic abnormality– Paralysis

• Quadriplegia/paraplegia• High spinal cord injury can cause respiratory failure

– Paresthesia• Numbness or tingling below level of injury

– Other

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Assessment

Assess for hazards Mechanism of injury

– Initial assessment• The patient with a spinal cord injury may require

ventilatory assistance

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Assessment

Focused history and physical exam– Vital signs

• Hypotension without tachycardia• Flushed, warm skin

– History• Mechanism of injury• The patient’s neurologic status

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Management

Save the patient– Address the ABCs

Protect the cord– Perform all treatment with protection of the cord in

mind– Position the patient with the head in a neutral

position and maintain in-line immobilization of the head and spine

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Management

Cervical spine immobilization device– Semi-rigid device that fits around patient’s neck to

discourage movement– A rolled-up towel can be used– Ensure manual stabilization even after the collar

has been applied

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Management

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Cervical Collar

Watch this clip demonstrating application of the cervical collar

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Management

Short immobilization device– Used if a patient is seated and has a suspected

spinal injury– Apply cervical collar first– Secure the torso, then the head– Transfer patient to a long spine board

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Short Immobilization Device

Watch this clip to see how the short immobilization device is used

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Management

Rapid extrication– Used when the patient must be removed quickly– Provide manual stabilization– Keep the spine in line

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Management

Long spine board– Used for patients found standing or lying down– Supine patient

• Holding head and neck, roll patient to supine position• Check PMS functions• Apply a collar• Move patient onto the long spine board

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Log Roll

Watch this video demonstrating the log roll procedure

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Management

Long spine board– Standing patient

• Perform standing takedown maneuver• Requires no movement on the patient’s part

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Management

Special considerations– Helmets

• Helmet may remain in place if it allows assessment and management of patient’s airway, breathing, and immobilization– Typical sports helmet—fairly easy access– Motorcycle helmet—management of airway difficult

• EMT must not compromise spine during removal

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Management

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Management

Special considerations– Pediatric

• Use pediatric immobilization boards • Use long spine board with pad from

shoulders to heels

– Geriatric• Use padding for excess spinal curvature

(scoliosis, kyphosis)

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Management

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Transport

Establish prompt transport Follow local protocols regarding the facility Provide ongoing assessment Document and advise staff of any changes

in patient condition

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Stop and Review

Describe how to apply a cervical collar. Describe when rapid extrication from a

vehicle is indicated.

chapter 22 spine injuries. © 2005 by thomson delmar learning,a part of the thomson corporation. all...

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