version: 3.0 010908 saving lives skills for life spinal management certificate
TRANSCRIPT
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Housekeeping
Phones/ Pagers ExitsCourse Timings &
Breaks
Facilities Assembly Point
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Resources
• PowerPoint Handout
• Spinal Management Learner Guide
• Assessment Activity Booklet
• Facilitator Guide
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Learning Outcomes
• Hold a basic understanding of spinal cord anatomy and injuries
• Describe the possible causes of spinal injuries• Detail the signs and symptoms of a patient with
suspected spinal injuries• Detail the principles of immobilisation for spinal injuries• Detail and demonstrate the management of head and
spinal injuries• Demonstrate how to move a casualty with suspected
spinal injuries
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Introduction
This non-accredited course is designed to link existing knowledge with more detailed information so best practice spinal management techniques are achieved in your workplace
The information given:• Focuses on principles of good spinal care in an
emergency situation• Provides a range of management options• Enables the learner to develop individual management
plan specific to each incident• Allows for organisational practices to be included• Draws on trained and untrained rescuers
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Spinal cord injury
• SLSA recorded 158 suspected spinal injuries between August 2006 and July 2007.
• Each year 50 people are injured in diving accidents in Australia.
• Average cost to support a person who has sustained a major spinal injury is over $1,250,000 per person.
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SPINAL CORD INJURY SCI Classifications
• Traumatic – resulting from an external causes
• Non-traumatic – caused by medical conditions
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SCI Treatment Centres
Australia has 6 hospitals that care for SCI patients.
They are located in the following 5 states.
QLD – Princess Alexandra Hospital
NSW – Royal North Shore Hospital & St James Hospital
VIC – Austin Hospital
SA – Royal Adelaide Hospital
WA – Royal Perth Rehabilitation Hospital
Tasmania, NT and the ACT do not have Spinal Units, patients are sent to the nearest interstate Spinal Unit.
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Spine & Nervous System
Spine 42 cm long
33 vertebrae
Allows movement, twisting and bending of the spine
Natural ‘S’ curve
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Spinal column• Vertebrae
– Protects spinal cord– Provides support to the body– Outer section bony mass offers point of
attachment– Inner hollow provides a passageway for spinal
cord to run through• Cerebrospinal fluid (CSF) acts as cushion
against injury• 31 spinal nerves running from spinal column
communicate with whole body
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Nervous system
Divides into two parts• Central Nervous System (CNS)
– Dorsal cavity– Cranial subcavity– Spinal cavity
• Peripheral Nervous System (PNS)– Somatic nervous system– Sympathetic nervous system– Parasympathetic nervous system
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5 Mechanisms of SCI
• Hyperextension• Hyperflexion• Compression• Distraction• Rotation
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5 Mechanisms of SCI
• Hyperextension– Spine arched backwards
beyond normal limits– Type of injury most
commonly in the upper cervical section of spinal cord
– Common causes are motor vehicle accidents and shallow water diving accidents
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5 Mechanisms of SCI
• Hyperflexion– Spine arched forwards
beyond normal limits– Type of injury most
commonly in the upper cervical section of spinal cord
– Common causes are whiplash or falling down stairs.
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5 Mechanisms of SCI
• Compression– Spinal cord is compressed– Commonly results in injuries
to C5-6 and T12-L1– Common causes diving
injuries and impacting windscreens in motor vehicle accidents
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5 Mechanisms of SCI
• Distraction– Overstretching of the spinal cord– Caused by hanging injuries or playground injuries to children
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5 Mechanisms of SCI
• Rotation– Head and body rotate in
opposite directions– Common causes are motor
vehicle accidents and if ejected from the vehicle
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Common causes of SCI
• motor vehicle accident• industrial accident (workplace)• diving accident• sporting accident• a fall from a height• a significant blow to the head• severe penetrating wounds (i.e. gunshot)
SLSA/ALA v1.0 Apr 2008
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SCI Types of injury
Tetraplegia or (Quadriplegia): – ‘Paralysis of four limbs’– Impairment or loss of motor or sensory function in the cervical
segments of the spinal cord. – At this level, arms and legs are affected
Paraplegia:– Paralysis of both lower extremities– Impairment or loss of motor or sensory function in the thoracic,
lumbar or sacral segments of the spinal cord. – At this level, the SCI patient will still have arm function
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Signs & symptomsSignsBreathing difficulties*Loss of consciousness or fading in &
out*Loss of function in hands, fingers, feet
or toes*Loss of bladder or bowel control*Neck or head in abnormal position*Dilated pupilsFluid leaking from the earsAbnormal blood pressureProfuse bleeding from the head Abrasions or bruising to the head or
foreheadShock
Symptoms
Back or neck pain (intense*)
Tingling or lack of feeling in lower or upper limbs
Increased muscle tone
Headache or dizziness
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Secondary injury
First responders prevent further injury through the application of sound incident management practices; i.e.
• Preventing further movement• Oxygen therapy• Correctly preparing patient for transportation• Accurately record the patient’s vital signs, incident details
and provide first aid• Treat patient for shock
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How to classify SCI?
Complete Injuries:Complete SCI are total loss of motor function (paralysis)
and sensory perception is a result of interruption of the ascending and descending nerve tracts in the spinal cord.
Incomplete Injuries:There is some function below the level of SCI67% of SCI in Australia are incompletePoor management of the patient with incomplete SCI
can cause progressive worsening of spinal cord function
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Special considerations
Padding under • child or infant’s torso • Biker’s torso
will assist in aligning patient’s head to the neutral position
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Primary survey – SCI patient
D – Danger
R – Response
A – Airway management and cervical spine stabilization
B – Breathing (ventilation)
C – Circulation and bleeding
D – Defibrillation
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Check for contraindicationsConscious patient• Patient’s head or part of their
torso is tilted and the patient is unable to move from that position
• Moving the patient’s head or spine can not be performed because of space limitations or other conditions.
• Airway obstruction• Breathing Difficulties
Unconscious patient• Not Breathing• Moving the patient’s head or
spine can not be performed because of space limitations or other conditions.
• Airway obstructions
Where a contraindication becomes evidence STOP the course of action immediately and immobilise the patient as is.
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Remove motorcycle helmet?
Reasons that it may be necessary to take off a casualty’s helmet at the scene of the accident include:
• to obtain a clear airway (conscious or unconscious patient)
• for oxygen therapy to be administered• to apply a cervical collar• to place the patient’s head into a neutral position, as the
helmet has lifted the head into hyperflexion.
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Types of spinal immobilisation & retrieval equipment
Step 1• minimise further movement of patient’s head by using -
– manual stabilisation – standing or supine– vice grip.
Step 2• Fit cervical collar
Step 3 • Utilise lifting and carrying devices
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Types of spinal immobilisation & retrieval equipment
• Head block• Immobilisation strapping• Spine board (long spine board or backboard)• Scoop stretcher• Stokes basket• Extrication device & stretchers
SLSA/ALA v1.0 Apr 2008
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Types of spinal immobilisation & retrieval equipment
See Learners Manual pages 29 to 38.
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Cervical collar
• Applied by trained and experienced personnel only• Check manufacturer’s fitting instructions• Ideally two people to fit collar
– Rescuer one performing manual stabilisation– Rescuer two fits collar
• Communicating your actions with the conscious patient is critical.
Manual stabilisation must continue after the fitting of the cervical collar.
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Cervical collar - supine patient
The same steps apply as for a standing or seated patient.
Except, fold in Velcro fasteners to protect from contamination by sand or gravel.
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Safe transportation of a patient
Australian Resuscitation Council advise that an injured or unconscious patient’s condition can be worsened by movement.
If movement is necessary of a conscious patient, extreme care must be taken to minimise movement of the spine in any direction, and the painful area must be fully supported.
Airway management takes precedence over any suspected spinal injury in an unconscious patient
Guideline 8.18 www.resus.org.au
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Log roll
Cervical collar fitted first
Accepted method to position a patient on their side
Allows for placement of blanket, board or litter against spine
Positions patient’s arms down either side of torso
Supports thoracic/lumbar area against sagging
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Backboard sitting patient
Cervical collar fitted first
Allows for minimal movement to patient’s spinal column
Minimum 3 people to perform this technique
Back board lowered to ground
Patient is slid along board in 30 cm increments to correct position
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Aquatic rescue (pool or still water)
Rescuer to move cautiously towards patient
Minimise water movement around patient
Stabilise patient’s head using either• Vice grip technique• Extended arm roll-over technique (surf retrieval)• Fit cervical collar
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Trapezius gripThe trapezius grip is used to support the patient’s head and
neck, whilst allowing the fitting of a cervical collar.• Grip upper trapezius muscle between thumb and the
fingers, supporting the head between the forearms (held vice-like along side of head)
• To allow for the cervical collar to be fitted, the rescuer grips the trapezius muscle between the extended middle and ring fingers (forming a V-shape).
• The forearms continue to provide firm support to the head
See Learners Manual p.65
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Preparing patient for transport• Immobilisation strapping is fitted before moving the
patient from the water.• Chest strap is secured first, followed by hip or feet (see
manufacturer’s guidelines) and finally the head strap is applied.
• Manual stabilisation continues at all times until handover• Reassure the conscious patient continually• Monitor patient’s body temperature (shock to nervous
system affects ability to self-regulate)• Protect patient from elements; sun to eyes, wind on
body, etc.
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Preparing patient for transport
Key considerations when moving the patient on a spinal board.
• Always move patient in head first direction• Avoid lifting one end of the board higher than the other –
keep horizontal, or head higher on stairs• Do not slide spine board across the ground or surface, it
may catch and jerk or jolt the patient• Ensure hair, jewellery and clothing is clear and can not
catch against surfaces or become caught in the rescuers hands, straps, etc.
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OHS considerations
Observe OHS recommendations when lifting patient from ground level use a minimum of 4 people to lift.
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Practical demonstration
Now move to the pool or a still water environment to practice your spinal management techniques.