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