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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

Spinal Immobilization

Tricks of the Trade

objectives
Objectives
  • Statistics
  • Anatomy review
  • Mechanism of injury
  • Purpose
  • Available equipment
  • Techniques
statistics
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
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
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
Trivia
  • The praying mantis
spinal shock neurogenic
Spinal Shock (Neurogenic)
  • Normal sympathetic stimulation
    • Heart rate
    • Blood pressure
      • vasoconstriction
spinal shock neurogenic1
Spinal Shock (Neurogenic)
  • Hypovolemia from trauma
    • Tachycardia
    • hypotensive
  • High cervical cord injury
    • Bradycardic
    • Hypotensive
    • Narrowing pulse pressure
neuro assessment
Neuro assessment
  • Know what the patients neuro status is prior to packaging
    • Movement
    • Sensation
    • Strength
  • Compare after extrication
the perfect package job
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.?
slide30

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
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
The Great Helmet Debate
  • Football
    • Helmet/pad go together
    • Critical airway?
    • Chest trauma?
the great helmet debate1
The Great Helmet Debate
  • Motorcycle helmets
    • Usually a good fit
    • No pads to keep pt. inline
    • Should be removed or padded under shoulders