Spinal TraumaSpinal

Trauma

Learning ObjectivesLearning Objectives

At the end of the presentation the student will be able to• Describe the assessment finding associated with head and spinal

injuries.• Identify the need for rapid transportation of the patient withheld and

spinal injuries.• Describe the assessment finding associated with traumatic spinal

injuries. • Differentiate between spinal injuries based upon the assessment

and the history.• Formulate a field impression based upon the assessment of spinals

injuries.• Develop a patient management plan based upon the field

impression.• Describe the management of the traumatic spinal injury patient.

IntroductionIntroduction

• 1.25 Million to care for a single victim• Overall life span

• 15,000 - 20,000 SCI /year• Higher in Men 16 - 30 yrs old• Causes

• MVA 2.1 million per yr (48%)• Falls (21%)• Penetrating Injuries (15%)• Sports injuries (14%)

Morbidity and mortalityMorbidity and mortality

• 40% of trauma patient with neuro deficit will have temporary or permanent SCI

• 25% of SCI may be caused by improper handling

Anatomy reviewAnatomy review

• Cervical - 7• Thoracic - 12• Lumbar - 5• Sacral - 5• Coccyx - 4 (1)

Vertebral BodyVertebral Body• Transverse

process• Spinous process• Intervertebral

foramen• Intervertebral Disk

Spinal NervesSpinal Nerves

AssessmentAssessment

• Positive MOI• High speed MVA• Falls > three x height• Stabbing• GSW• Sports injuries• ????

Critical CriteriaCritical Criteria

• Initial management based upon MIO

• Positive MIO - immobilize

• Uncertain MIO - further assessment

Milwaukee County ProtocolMilwaukee County ProtocolInitiated: 9/12/01 MILWAU KEE COUNTY

EMSApproved by: Ronald Pirrallo, MD,MHSA

Reviewed/revised: STANDARD OF CARE Signature:Revision: SPINAL

IMMOBILIZATIONPage 1 of

With careful assessment, a patient who has sustained minor blunt trauma may not require spinalimmobilization.

Immobilize

Determine mechanism of injury

Yes

Monitor and transportby appropriate

EMS unit

No

Patient is conscious(alert), cooperative, able to

communicate, and can concentrateand cooperate

with exam?

Reevaluate for:-altered level of consciousness

-clinical intoxication-distracting injuries

-new onset or temporary paralysis-midline or paraspinal back or neckpain or tenderness upon palpation

At least one findinglisted above?

Yes

ALS warrantedby protocol?

No

May deferimmobilization

Yes

No

NOTES: This policy does not exclude any patient from immobilization if the EMS team feels c-spine/spinal

immobilization precautions are warranted. Communication barriers include, but are not limited to: age, language, closed head injury, deafness,

intoxication, or other injury that interferes with patient’s ability to concentrate on or cooperate with theexamination (i.e. patient is distracted), etc.

Neck pain includes any stiffness or tenderness upon palpation at the posterior midline or paraspinal areaof the cervical spine or back.

It is important to determine whether the patient is unable to concentrate on exam due to other injuries,events, or issues (i.e. patient is distracted). Other injuries may actually serve as markers for high-energytrauma that could result in multiple other significant injuries, including cervical spine injuries.Distracting injuries include, but are not limited to: fractures, lacerations, burns, and crush injuries.

Documentation on the run report should reflect negative physical findings as outlined above.

Asses for spinal painAsses for spinal pain

• Any related spinal pain• Any pain with

movement

• Signs • Symptoms• Palpate over each

spinous process• Sensory function• Motor function

Management for Spinal InjuriesManagement for Spinal Injuries

• Prevent further injury• Treat as long bone with joint at either

end• 15% of secondary injuries are

preventable• ALWAYS complete spine ALWAYS complete spine

immobilizationimmobilization• Reassess after immobilization

ImmobilizationImmobilizationImmobilizationImmobilization

• Cervical immobilization

• KED• Long board• Padding• Straps• Cervical

immobilization Device

Helmeted PatientsHelmeted Patients

• Indications for leaving a hemet in place.• Indications for helmet removal

CaseCase

• You are dispatched to a single vehicle MVA.

• Upon arrival you find a unconscious not breathing patient laying across the front seat of the vehicle.

• What are your priorities?

• How do you achieve them?

• The patient is rapidly extricated and placed on a long board with in-line stabilization.

• The space between the board and the head was approximately 6”

• What would you do?

• He is placed in the ambulance and ventilation is attempted without success.

• What would you do now??

• Using a laryngoscope you observe a “Breath saver” lodged on the vocal cords.

• It is removed.• Would to intubate this patient??

• The patient is intubated and two large bore IV are placed.

• Vital signs• Resp - ventilated• Pulse - 110• BP - 140/76• AVPU - unresponsive• Pupils - sluggish

• Patient is transported without delay.

• Upon arrival to the Level I Trauma Center the patients condition is unchanged.

• X-ray• Labs• ET placement is confirmed with X-ray

• The patient is admitted to TLC• His cervical spine is repaired• His thoracic spine is repaired• His lumbar spine is repaired• His closed head injury/skull fx is treated

with observation

• He recovers full in approximately 6 weeks• No neurological deficits