Spinal Immobilization Tricks of the Trade

Objectives Statistics Statistics Anatomy review Anatomy review Mechanism of injury Mechanism of injury Purpose Purpose Available equipment Available equipment Techniques Techniques

Statistics 11,000 spinal cord injuries/year 11,000 spinal cord injuries/year 55% of injuries are years old 55% of injuries are years old Average age is 32 Average age is 32 82% are male 82% are male 51.6%>tetraplegia 51.6%>tetraplegia 46.3%>paraplegia 46.3%>paraplegia

Cord Anatomy Largest nerve Largest nerve Base of brain to L-2 Base of brain to L-2 Level of cord injury will determine Level of cord injury will determine  Pt. outcome  Physical response  Signs & Symptoms  D-2

Effects on breathing “C3,4,5 keep the diaphram alive” “C3,4,5 keep the diaphram alive” Phrenic nerve innervates the diaphram Phrenic nerve innervates the diaphram Look for diaphragmatic breathing pattern 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 Normal sympathetic stimulation  Heart rate  Blood pressure  vasoconstriction

Spinal Shock (Neurogenic) Hypovolemia from trauma Hypovolemia from trauma  Tachycardia  hypotensive High cervical cord injury High cervical cord injury  Bradycardic  Hypotensive  Narrowing pulse pressure

Neuro assessment Know what the patients neuro status is prior to packaging Know what the patients neuro status is prior to packaging  Movement  Sensation  Strength Compare after extrication Compare after extrication

Mechanism of Injury

Bullet

Permanent damage?

The perfect package job It doesn’t matter how nice he is packaged when he arrives at the ER It doesn’t matter how nice he is packaged when he arrives at the ER What is important is how he got there What is important is how he got there 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 packaging and transport Minimize further movement during packaging and transport  Improvise when necessary  Be creative Minimize neurological effects Minimize neurological effects  Long term effects  A little bit means a lot (Sally)

Devices Available

The Great Helmet Debate Football Football  Helmet/pad go together  Critical airway?  Chest trauma?

The Great Helmet Debate Motorcycle helmets Motorcycle helmets  Usually a good fit  No pads to keep pt. inline  Should be removed or padded under shoulders