Neck & Back injuries

C3-5 keep the diaphragm alive

Head is heavy

Physiology

Mechanism Of Injury (speed/force, direction)

Get as much info as possible! (Bystanders?) – pass onto crew

Lateral forces more damaging

50% to cervical region – very delicate

Injury

Danger – traffic, people, animals Response – AVPU (think about where you stand when

talking) Summon help! Airway (& C-spine) Breathing Circulation Dysfunction Exposure

Assessment (Primary Survey!!)

To immobilise or not to immobilise If M.O.I suggests immobilise, do it.

Airway (& C-spine)

Neutral alignment (adults / children) What if there’s pain / resistance?

How do we open the airway??

Airway (& C-spine) - Immobilised

Jaw thrust (2 movements) – why? (Avoid causing axial pressure)

What if jaw thrust doesn’t work??

Airway (& C-spine) – Jaw Thrust

Are they breathing?? Rate, ease, depth, regularity (might be

affected by spinal cord injury)

Breathing

Neurogenic shock → slow pulse & low BP Changes in skin colour

Circulation

Look Feel (Move)

Dysfunction: Assessment• Pain• Tenderness• Irregularity

• Sensation• Pins &

needles• MovementKeep Pt calm!!

Priaprism

25% of spinal cord injuries result from improper handling after injury

DRS A,B 999! LOG ROLL – why/when? Reassure Obs / mental status (beyond AVPU)

Management

To immobilise or not to immobilise? What influences this?

Airway (& C-spine)

Normal mental status No neurological deficit No spinal pain / tenderness No evidence of intoxication No extremity injury

If in doubt, immobilise !! If M.O.I suggests spinal injury… IMMOBILISE

C-spine Clearing Protocols (YAS)

• Decreased consciousness (GCS <15)?• L.O.C?• Neurological S&S

(tingling, numbness…)?• SIGNIFICANT neck/back

pain?• Deformity, swelling,

tenderness?• SIGNIFICANT pain on

moving neck/back?• Drink/drugs (inc.

prescribed)?• Other painfull

(distracting) injuries?

Scenarios

http://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/clinical_guidelines_2006.pdf

If you’re bored…