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Spinal Immobilization. Tricks of the Trade. Objectives. Statistics Anatomy review Mechanism of injury Purpose Available equipment Techniques. Statistics. 11,000 spinal cord injuries/year 55% of injuries are 16-30 years old Average age is 32 82% are male 51.6%>tetraplegia
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Spinal Immobilization Tricks of the Trade
Objectives • Statistics • Anatomy review • Mechanism of injury • Purpose • Available equipment • Techniques
Statistics • 11,000 spinal cord injuries/year • 55% of injuries are 16-30 years old • Average age is 32 • 82% are male • 51.6%>tetraplegia • 46.3%>paraplegia
Cord Anatomy • Largest nerve • Base of brain to L-2 • Level of cord injury will determine • Pt. outcome • Physical response • Signs & Symptoms • D-2
Effects on breathing • “C3,4,5 keep the diaphram alive” • Phrenic nerve innervates the diaphram • Look for diaphragmatic breathing pattern • Most air movement is accomplished with chest expansion, not pulling of diaphram
Trivia • The praying mantis
Spinal Shock (Neurogenic) • Normal sympathetic stimulation • Heart rate • Blood pressure • vasoconstriction
Spinal Shock (Neurogenic) • Hypovolemia from trauma • Tachycardia • hypotensive • High cervical cord injury • Bradycardic • Hypotensive • Narrowing pulse pressure
Neuro assessment • Know what the patients neuro status is prior to packaging • Movement • Sensation • Strength • Compare after extrication
The perfect package job • It doesn’t matter how nice he is packaged when he arrives at the ER • What is important is how he got there • Sandbags, towels, blankets, etc.?
Can you think outside the box when it is necessary? Do you have enough KED’s, collars, backboards or straps?
What is the goal anyway? • Minimize further movement during packaging and transport • Improvise when necessary • Be creative • Minimize neurological effects • Long term effects • A little bit means a lot (Sally)
The Great Helmet Debate • Football • Helmet/pad go together • Critical airway? • Chest trauma?
The Great Helmet Debate • Motorcycle helmets • Usually a good fit • No pads to keep pt. inline • Should be removed or padded under shoulders