Spinal Immobilization
Tricks of the TradeTricks of the Trade
Objectives
StatisticsStatistics Anatomy reviewAnatomy review Mechanism of injuryMechanism of injury Purpose Purpose Available equipmentAvailable equipment Techniques Techniques
Statistics
11,000 spinal cord 11,000 spinal cord injuries/yearinjuries/year
55% of injuries are 55% of injuries are 16-30 years old16-30 years old
Average age is 32Average age is 32 82% are male82% are male 51.6%>tetraplegia51.6%>tetraplegia 46.3%>paraplegia46.3%>paraplegia
MVA
Violent Falls
SportsOther
0
5
10
15
20
25
30
35
40
Cord Anatomy Largest nerveLargest nerve Base of brain to L-2Base of brain to L-2 Level of cord injury Level of cord injury
will determinewill determine Pt. outcomePt. outcome Physical responsePhysical response Signs & SymptomsSigns & Symptoms
D-2D-2
Effects on breathing
““C3,4,5 keep the diaphram alive”C3,4,5 keep the diaphram alive” Phrenic nerve innervates the Phrenic nerve innervates the
diaphramdiaphram Look for diaphragmatic breathing Look for diaphragmatic breathing
patternpattern Most air movement is Most air movement is
accomplished with chest accomplished with chest expansion, not pulling of diaphramexpansion, not pulling of diaphram
Trivia
The praying The praying mantismantis
Spinal Shock (Neurogenic)
Normal sympathetic stimulation Normal sympathetic stimulation Heart rateHeart rate Blood pressureBlood pressure
vasoconstrictionvasoconstriction
Spinal Shock (Neurogenic)
Hypovolemia from traumaHypovolemia from trauma TachycardiaTachycardia hypotensivehypotensive
High cervical cord injury High cervical cord injury BradycardicBradycardic HypotensiveHypotensive Narrowing pulse pressureNarrowing pulse pressure
Neuro assessment
Know what the patients neuro Know what the patients neuro status is prior to packagingstatus is prior to packaging MovementMovement Sensation Sensation StrengthStrength
Compare after extricationCompare after extrication
Mechanism of Injury
Bullet
Permanent damage?
The perfect package job
It doesn’t matter how nice he is It doesn’t matter how nice he is packaged when he arrives at the packaged when he arrives at the ERER
What is important is how he got What is important is how he got therethere
Sandbags, towels, blankets, etc.?Sandbags, towels, blankets, etc.?
Do you have enough KED’s, collars, backboards or straps?
Can you think outside the box when it is necessary?
What is the goal anyway?
Minimize further movement during Minimize further movement during packaging and transportpackaging and transport Improvise when necessaryImprovise when necessary Be creativeBe creative
Minimize neurological effectsMinimize neurological effects Long term effectsLong term effects A little bit means a lot (Sally)A little bit means a lot (Sally)
Devices Available
The Great Helmet Debate
FootballFootball Helmet/pad go Helmet/pad go
togethertogether Critical airway?Critical airway? Chest trauma?Chest trauma?
The Great Helmet Debate
Motorcycle helmetsMotorcycle helmets Usually a good fitUsually a good fit No pads to keep No pads to keep
pt. inlinept. inline Should be Should be
removed or removed or padded under padded under shouldersshoulders