Neck & Back injuries
33 in total
Physiology
C3-5 keep the diaphragm alive
T attach to ribs (stronger)
Which is weakest? (C? T? L?)
Weakest during side-to-side movement
Physiology
Mechanism Of Injury (speed/force, direction)
Get as much info as possible! (Bystanders?) – pass onto crew
Examples? Lateral forces more
damaging Common injury sites: C1/2,
C7/T1, T12/L1 50% to cervical region
Pathophysiology
Danger – traffic, people, animals Response – AVPU (think about where you stand when
talking) Summon help Airway (& C-spine) Breathing Circulation Dysfunction Exposure
Assessment (Primary Survey!!)
To immobilise or not to immobilise If M.O.I suggests immobilise, do it.
Airway (& C-spine)
Neutral alignment (adults / children) What if there’s pain / resistance? Jaw thrust (2 movements) – why?
(Avoid causing axial pressure)
What if jaw thrust doesn’t work??
Airway (& C-spine) - Immobilised
Are they breathing?? Rate, ease, depth, regularity (might be
affected by spinal cord injury)
Breathing
Neurogenic shock → slow pulse & low BP Changes in skin colour
Circulation
Look Feel (Move)
Dysfunction: Assessment• Pain• Tenderness• Irregularity
• Sensation• Parasthesia?• Movement• Odd sensations
Keep Pt calm!!
Priaprism
25% of spinal cord injuries result from improper handling after injury
DRS A,B 999! LOG ROLL – why/when? Reassure Obs / mental status (beyond AVPU)
Management
To immobilise or not to immobilise? What influences this?
Airway (& C-spine)
Normal mental status No neurological deficit No spinal pain / tenderness No evidence of intoxication No extremity injury
If in doubt, immobilise !! If M.O.I suggests spinal injury… IMMOBILISE
C-spine Clearing Protocols (YAS)• Decreased
consciousness (GCS <15)?• L.O.C?• Neurological S&S
(tingling, numbness…)?• SIGNIFICANT neck/back
pain?• Deformity, swelling,
tenderness?• SIGNIFICANT pain on
moving neck/back?• Drink/drugs (inc.
prescribed)?• Other painfull
(distracting) injuries?
Scenarios
http://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/clinical_guidelines_2006.pdf
If you’re bored…