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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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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Moving the Patient
Watch this animation of how moving the patient with a spinal cord injury could cause further injury
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Spinal Injuries
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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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Spinal Injuries
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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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Spinal Injuries
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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Types of Spinal Injuries
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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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Types of Spinal Injuries
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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Patient Presentation
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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Patient Presentation
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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Patient Presentation
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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Patient Presentation
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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Patient Presentation
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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Patient Presentation
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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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Patient Presentation
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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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Patient Presentation
Neurologic abnormality– Respiratory failure
• Caused by damage to C3, C4, C5 • Diaphragm is necessary for effective breathing
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Patient Presentation
Neurologic abnormality– Neurogenic shock
• Vasodilation• Patient appears flushed• Heart rate remains normal• Hypotension
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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Patient Presentation
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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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
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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© 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved
Stop and Review
Describe how to apply a cervical collar. Describe when rapid extrication from a
vehicle is indicated.