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25 Cards in this Set
- Front
- Back
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What is hyperextension and what can cause it?
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Excessive posterior movement of the head or neck
Examples: Face into windshield in an MVC Elderly person falling to the floor Football tackler Dive into shallow water |
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What is hyperflexion and what can cause it?
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Excessive anterior movement of head onto chest
Examples: Rider thrown of horse or motorcycle Dive into shallow water |
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What is compression and what can cause it?
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Weight of head or pelvis is driven into stationary neck or torso
Examples: Dive into shallow water Fall of greater than 10-20 feet onto head or legs |
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What is rotation and what can cause it?
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Excessive rotation of the torso or head and neck moving one side of the spinal column against the other.
Examples: Rollover MVC Motorcycle crash |
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What is lateral stress and what can cause it?
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Direct lateral force on the spinal column typically shearing one level of cord from another
Examples: T-bone MVC Fall |
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What is distraction and what can cause it?
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Excessive stretching of column and cord
Examples: Hanging Child inappropriately wearing shoulder belt around neck Snowmobile or motorcycle under rope or wire |
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What is primary damage of the spinal cord?
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Occurs at the time of the trauma and resulting from the cord being cut, torn, crushed or its blood supply being cut off.
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What is secondary damage?
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Occurs from hypotension, generalized hypoxia, injury to blood vessels, swelling or compression of the cord from surrounding hemorrhage.
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What kind of shock can occur with spinal cord injury?
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Neurogenic shock. This will present without the usual cool clammy skin and tachycardia as the signals to release catecholamines cannot get through.
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What are some MOI clues that should point to spinal cord injury?
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-Blunt trauma above the clavicle
-Diving accident -Motor vehicle or bicycle accident -Fall -Stabbing or Impalement anywhere near the spinal column -Shooting or blast injury near the torso -Any violent injury with forces that could act on the spinal column or cord |
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What are some Patient complaints?
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-Neck or back pain
-Numbness or tingling -Loss of movement or weakness |
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What are some signs revealed during assessment?
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-Pain on movement of back or spinal column
-Obvious deformity of back or spinal column -Guarding against movement of back -Loss of sensation -Weak or flaccid muscles -Loss of control of bladder or bowels -Erection of the penis -Neurogenic shock |
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What are the two situations where you can modify usual spinal restriction?
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The patient who is in immediate danger of death in a hostile environment, unstable structure or vehicle needing an emergency rescue.
The second situation that requires modification is for patients that need an intervention within 1 - 2 minutes. |
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What are indications for rapid extraction for patients needing critical interventions?
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Airway obstruction that cannot be relieved by modified jaw thrust or finger sweep
Cardiac or respiratory arrest Chest or airway injuries needing ventilation or assisted ventilation Deep shock or bleeding that cannot be controlled |
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What is rapid extrication?
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Requires multiple rescuers to move the patient along the long axis of the body using hands to minimize spinal movement.
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What special considerations can be needed with the heads or adults and infants?
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In order to maintain a neutral position you may need to use towels or padding under the shoulders or the back of the head.
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What can happen with some frightened patients and patients with altered mental status?
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They can struggle violently and defeat attempts to eliminate spinal movement.
In these cases carefully document where the patient refuses to cooperate with SMR |
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How should women who are more than 20 weeks pregnant be positioned for transport on a backboard?
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Should be tilted 20-30 degrees to the left side in order to keep the uterus off the inferior vena cava.
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How are patients with airway problems best transported?
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On their side, this is especially critical when there is uncontrolled bleeding into the airway or massive face or neck trauma.
In these situations gravity helps drain fluids out of the airway and may prevent aspiration if the patient vomits. Due to the danger of vomiting and aspiration, unconscious patients who are not intubated should be transported rolled to the side. |
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What are some complications of SMR?
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The patient will be uncomfortable and will often complain of head and low back pain related to the board
The head and neck are fixed which can result in aspiration if the patient vomits. Obese patients and those with CHF can suffer life-threatening hypoxia Uneven skin pressure can result in pressure sores |
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Spinal Motion restriction is indicated in trauma patients with a significant mechanism of injury and one of which criteria?
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Altered mental status
Evidence of intoxication A distracting painful injury Neurological Deficit Spinal pain or tenderness |
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What are positive mechanisms of injury for SMR regardless of the patient findings?
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High speed MVC
Falls 3x Patients height Axial Load Diving accidents Penetrating wound in or near the spinal column Sports injuries to Head or Neck Unconscious trauma patient |
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What are some guidelines for spinal immobilization in pediatric patients?
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Better to use hands and then towel rolls to secure provide SMR
Can use a towel as padding under the back and shoulders to put the head in a more neutral position Children with no apparent injuries can be packaged in their car seat as long as there is no damage to the seat. Children in damaged seats or with injuries must be carefully extracted and placed on a suitable device Scared and frightened children can struggle and there is nothing you can do other than try to calm them as best as possible. |
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What can be required with elderly patients?
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Flexibility, may need to use blankets, pillows or other such padding to fill voids created by kyphosis or lordosis.
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What are considerations for patients with neck wounds?
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Things like mandible fractures can compromise the airway. Open neck wounds need to be monitored.
It is more effective to use manual stabilization and head cushions or blanket rolls for CMR |
