1. Unit 35
Spinal Injuries

2. Overview Spinal column instability Mechanism of injury
Types of spinal cord injuries
Signs and symptoms of spinal injury
Manual stabilization
Spinal immobilization principles

3. Introduction
Spinal cord injuries can leave patients with devastating neurologic injuries
Injuries can lead to permanent disability, paralysis, and death
Care provided by EMT has crucial impact on patient’s long-term outcomes
EMT must recognize spine injuries

4. Anatomy Review Cervical spine Spinal column in the torso
Cervical vertebrate
Spinal column in the torso
Thoracic and lumbar vertebrate
Figure 35.1 The spinal vertebrae are segments of bone, with a spinal lumen or canal for the spinal cord

5. Anatomy Review Spinal cord Nerve roots and dermatomes Anterior cord
Central cord
Posterior cord
Nerve roots and dermatomes
Sensory and motor nerves
Dermatome: map of spinal nerves and associated areas of sensation

6. Spinal Column Instability
Injuries to cervical spine can be life threatening or have lifelong implications
Hyperflexion: excessive forward bending of neck
Hyperextension: excessive backward bending of neck
Lateral bending: due to side impact

7. Spinal Column Instability (cont’d.)
Axial loading: sudden downward pressure causing compression
Axial distraction: cervical spine is pulled apart
Figure Axial loading can occur from force applied from above, such as when the top of the head impacts with the windshield of a car

8. Mechanism of Injury Motor vehicle collision Falls Gun shot wounds
Force may cause motion beyond normal range, damaging spinal column
Falls
Force of fall may fracture or burst bones resulting in spinal cord injury
Gun shot wounds
Bullet strike to spinal column will likely cause trauma and spinal cord injury

9. Mechanism of Injury (cont’d.)
Sports injuries
Collisions occurring during sports can result in force, causing injury
Associated injuries
EMT must consider spinal injury, if trauma sustained by body part close to spine
Assume trauma occurring above clavicles, to chest or abdomen, may also involve spine injury

10. Types of Spinal Cord Injuries
Spinal cord injury may result in lacerations, compression, and stretching
Primary spinal cord injury: occurs at time of incident
Secondary spinal cord injuries: result from improper handling of patient with potential spinal cord injury

11. Signs and Symptoms of Spinal Injury
Neck pain
Tenderness along spine
Obvious deformity of spine
Figure Point tenderness elicited by palpation of the posterior neck. Note that the patient has continuous manual
stabilization

12. Signs and Symptoms of Spinal Injury (cont’d.)
Respiratory distress or arrest
Diaphragm may stop contracting
Signs: extreme shortness of breath, respiratory difficulty, or apnea
Neurogenic shock
Caused by loss of nervous system control of blood pressure
Results in relative blood loss and hypotension

13. Figure 35.19 Neurogenic shock is notable by distal vasodilation,
manifest by warm and flushed skin, and bradycardia

14. Signs and Symptoms of Spinal Injury (cont’d.)
Paralysis
Depending on location of spinal cord injury, areas affected by paralysis differ
Quadriplegia, paraplegia, and paresthesia
Associated signs of spinal cord injury
Loss of control of bowels and/or bladder
Priapism: painful erection

15. Primary Assessment Always protect spine from further injury
High-priority: full spine immobilization and immediate transport
Low priority: proceed to secondary assessment at more measured pace

16. Considerations When Deciding on Spinal Immobilization
Any patient with significant mechanism of injury and distracting injury should be treated for spine injury
Assume spinal injury if patient is found unconscious and no one witnessed what caused patient’s condition

17. Manual Stabilization Goal: prevent further injury to spine
Neutral inline alignment
Reposition head and neck to natural anatomic position
Figure Neutral inline
alignment of the cervical spine

18. Distal Neurologic Function
Assesses peripheral neurologic function
Check extremities for movement and sensation
Look for signs of distal circulation
Confirm distal circulation, sensation, and movement (CSM) before and after patient is placed on long backboard

19. Cervical Spine Immobilization Device
Cervical collar: semi-rigid device used to maintain neutral inline alignment
Application of the cervical spine immobilization device
Move chin cup up chest until chin is trapped, then attach Velcro®

20. Special Problem of Helmets
Important for EMT to know whether it is safer to take helmet off or leave on
Keep helmet in place if well fitted and does not impede management of airway, breathing, and immobilization
Remove loose fitting helmets

21. Spinal Immobilization Principles
Immobilize entire length of spine using long backboard
Head immobilization
Head secured last to prevent neck injury
Pediatric challenges
Pediatric immobilization boards have dip in head section, allowing for child’s larger occiput
Geriatric challenges
Use padding for curvature of spine

22. Moving Patient to Long Backboard
Patient lying down
Four-person lift and slide
Long axis drag
Modified log roll
Orthopedic stretcher

23. Moving Patient to Long Backboard (cont’d.)
Seated patient
Use intermediate device to move patient
Rapid extrication
Remove seated patient quickly
Short spinal immobilization device
Secures spine in upright position
Standing patient
Perform standing takedown technique

24. Selective Spinal Immobilization
Selective spinal immobilization criteria
Negative mechanism of injury does not meet criteria
Isolated foot injury
Uncertain mechanism of injury requires further assessment to meet criteria
Slip and fall
Positive mechanism of injury meets criteria
High velocity motor vehicle impact

25. Selective Spinal Immobilization (cont’d.)
Assessment by clinical criteria
Determine neck pain, and extremity sensation and motor function
Unreliable patient examination
Use caution and immobilize patient
Preexisting medical conditions
Elderly patient may have brittle bones

26. Transport Pay special attention and handle patient gently
Provide extra padding
Get patient safely to most appropriate hospital in reasonable amount of time
Perform ongoing assessment

27. Conclusion
EMT’s quick recognition of potential for spinal cord injury can help prevent further damage from occurring
Careful immobilization while maintaining inline stabilization is key in managing patient who has sustained spinal injury