Spinal/Neck Trauma

Spinal/Neck TraumaBasic Trauma CourseMechanisms of InjuryFour different types of forces can be sustained leading to particular types of injuries:Hyperextension: rear-end crashesHyperflexion: head-on crashesRotational: spinning crashesAxial loading: diving

Incorrectly applied restraints may contribute to injury.Spinal ShockResults in a temporary loss of motor, sensory, and reflex functions below the level of lesion.

Onset varies-can be immediate to weeks.

May present with flaccid paralysis and loss of bowel and bladder function.

Refer to page 174 Table 10-4 for comparison of spinal shock versus neurogenic shock.Vertebral FractureCervical and Lumbar regions most frequently injured.Due to anterior and posterior ligament injuries dislocations can occur simultaneously with fractures. Vertebral stability depends on the integrity of the bones and ligaments. A stable fracture means there is:No potential for progressive impingement of the cordNo potential for displacement of injured bony areas during the healing process

Incomplete Spinal Cord InjuryHas preservation of motor or sensory function below the level of injury.Sacral sparingSigns and Symptoms demonstrated are different.

Sacral Sparing-intact perianal sensation, anal sphincter tone, and great toe flexor function.Refer to Page 176 Table 10-7 Incomplete Cord Syndromes.

Complete Spinal Cord InjuryLose of all motor and sensory function below the level of the lesion with flaccid paralysis of the musculature. Spinal Shock is the initial response.

Loss of pain, touch, temperature, pressure, vibration, and proprioceptionBilateral external rotation of the legs Loss of all reflexes as well as bowel and bladder functiondepending on the level of the injuryLoss of autonomic nervous system function which may result in hypotension and venous pooling in the extremities and may lead to neurogenic shockBradycardia and loss of thermoregulation also due to autonomic dysfunction. Patient may become poikilothermic (patient assumes the temperature of the environment)

Neck InjuryMOI generally blunt trauma.Assessment includes evaluation of integrity of cervical spine and the spinal cord.Neck trauma can result in injuries to the airway structures, blood vessels, esophagus, and endocrine structures.

Signs and symptoms of neck injury can include:Dyspnea and or tachypneaHemoptysisAirway obstruction from swelling (edema or expanding hematoma) or foreign bodies/substances including blood and vomitSubcutaneous emphysema of the neck, face, and suprasternal area (image)Penetrating wounds or impaled objects in the neck areaLoss of the normal prominence of the laryngeal regionDysphonia or a hoarse voiceDysphagia or difficulty swallowing

AssessmentInspect- Airway, Breathing, Motor Function, PriapismPalpate-Pulse rate, Skin temp, Sensory Function, Vertebral column, anal sphincter, sacral sparing

Airway- May have edema to neckBreathing-Increased work of breathing or abd muscle use may indicate cervical/upper thoracic lesions. Phrenic nerve that innervates the diaphragm is at C3-5, Nerve for intercostal muscles T1-12 affects ability to cough and deep breathe.Motor Function-Inability to perform gross motor movements indicates a lesion above the level of injury. Refer to page 177 Table 10-8.Priapism-parasympathetic nervous system stimulation, loss of sympathetic nervous system controlPulse-slow=neurogenic shock fast=hypovolemic shockSkin temp-warm dry=neurogenic shock, cool moist=hypovolemic shockSensory Function-Begin at area of no feeling and progress toward the area of feeling.Palpate-Pain, tenderness, crepitus, step off deformitiesSacral sparing-presence of sensation and tone with other deficits =incomplete cord injuryContinued evaluation of the patient is essential. Spinal cord injuries may progress due to edema of the cord or incorrect immobilization.Treatment ModalitiesCervical Spine immobilization until cleared.Full spinal immobilization until cleared by MD.Suction cautiously.IV FluidsVasopressors-Hypotension may be due to neurogenic shock instead of hypovolemia.Maybe steroids.Keep Warm.Prepare for Transfer.