Spinal Injury Management
Spinal injury management for the spine, comprised of 33 separate bones known as vertebrae, extends from the base of the skull to the coccyx. Each vertebra surrounds and protects nerve tissue contained within the spinal cord. Fractures or dislocations to the vertebral bones may create a spinal injury in the spinal cord.
The direct mechanical injury from the traumatic impact can compress or sever the nerve tissue. This is followed by secondary damage caused by ongoing bleeding into the spinal cord and continued swelling at the injury site and surrounding area. Caution must be taken when moving and managing a person with a suspected spinal injury.
A spinal injury can occur in the following regions of the spine.
• Cervical spine (the neck)
• Thoracic spine (the back of the chest area)
• Lumbar spine (the lower back region)
The cervical spine is the most vulnerable to spinal injury, which must be suspected in any person with injuries above the shoulders. More than half of the recorded spinal injuries occur in the cervical region. A suspected spinal injury of the neck, particularly if the person is unconscious, poses a dilemma for the rescuer because correct spinal injury management principles of airway management often cause some movement of the cervical spine and may cause further unpreventable injury to the region when undertaking CPR.
Most Common Causes Of A Suspected Spinal Injury
The most common recorded causes of spinal cord injury are:
• A motor vehicle, motorcycle or bicycle incident as an occupant, rider, or pedestrian
• An industrial accident in the workplace
• Diving or jumping into shallow water, or water with unseen obstacles, or being “dumped” in the surf
• Sporting accidents
• A fall from greater than standing height
• Falls from standing height in the elderly
• Receiving a significant blow to the head
• A severe penetrating wound from an external source like a gunshot
The symptoms and signs of a spinal injury depend on two factors.
- Firstly, the location of the injury.
- Firstly, the location of the injury.
- Secondly, the extent of the injury – whether there is just bone injury or associated spinal cord injury and whether the spinal cord injury is partial or complete. Diagnosing symptoms and signs in persons with an altered conscious state will be difficult.
Symptoms of spinal injury include:
• Pain in the injured region
• Tingling, numbness in the limbs and the area below the injury
• Weakness or inability to move the limbs (paralysis)
• Headache or dizziness
• Altered or absent skin sensation.
Signs of spinal injury include:
• Head or neck in an abnormal position
• Signs of an associated head injury
• Altered conscious state
• Breathing difficulties
• Change in muscle tone, either flaccid or stiff
• Loss of function in limbs
• Loss of bladder or bowel control
• Priapism (erection in males).
The priorities of management of a suspected spinal injury are
1. Calling for an ambulance
2. Management of airway, breathing and circulation
3. Spinal care
With attention to spinal alignment, an awareness of any potential spinal injury, and careful person handling is the key to harm minimisation.
The Conscious Person With Suspected Spinal Injury
Tell the person to remain still but do not physically restrain them if they are uncooperative. Those with significant spinal pain will likely have muscle spasms that act to splint their injury. Keep the person warm and as comfortable as possible flat on their back until help arrives.
If it is necessary to move the person from danger (out of the water, off the road), care must be taken to support the injured area and minimise movement of the spine in any direction. Ideally, only First Aid providers or health care professionals trained in the management of spinal injuries, aided by specific equipment, should move the person.
The Unconscious Person With Suspected Spinal Injury
Airway management takes precedence over any suspected spinal injury. It is acceptable to gently move the head into a neutral position to obtain a clear airway. If the person is breathing but remains unconscious, they should be placed in the recovery position. The person should be handled gently with no twisting. Aim to maintain spinal alignment of the head and neck with the torso, both during the turn and afterwards. In persons needing airway opening, use manoeuvres that are least likely to result in cervical spine movement. Jaw thrust and chin lift should be tried before head tilt.
Spinal Immobilisation Techniques And Devices
The clinical importance of prehospital immobilisation in spinal trauma remains unproven. There have been no controlled trials to study immobilisation techniques or devices on trauma persons with a suspected spinal cord injury. All existing studies have been retrospective or on healthy volunteers, manikins, or cadavers.
Cervical Collars For Neck And Spine Stabilisation
The use of semi-rigid (SR) cervical collars by First Aid providers is not recommended.
The potential adverse effects of SR cervical collars increase with duration of use and include:
• Unnecessary movement of the head and neck with the sizing and fitting of the collar
• Discomfort and pain
• Restricted mouth opening and difficulty swallowing
• Airway compromise should the person vomit
• Pressure on neck veins raising intracranial pressure (harmful to head-injured persons)
• Hiding potential life-threatening conditions
First Aid Spinal Injury Boards
First Aiders can use rigid backboards placed under the person if it becomes necessary to move the person. The benefits of stabilising the head will be limited unless the motion of the trunk is also controlled effectively during transport. Persons should not be left on rigid spinal boards. Healthy subjects left on spine boards develop pain in the neck, back of the head, shoulder blades and lower back.
The same areas are at risk of pressure necrosis. Conscious persons may attempt to move around to improve comfort, potentially worsening their injury. Paralysed or unconscious persons risk developing pressure necrosis due to their lack of pain sensation. Strapping has been shown to restrict breathing and should be loosened if compromising the person. Persons may be more comfortable on a padded spine board, air mattress or bead-filled vacuum mattress, devices used by some ambulance services.
Spinal Examination Method-Log Roll
The log roll is a manoeuvre performed by a trained team to roll a person from a supine position onto their side and then flat again to examine the back and/or place or remove a spine board.
Infants Should Be Left In Their Car Seats After An Accident
After road traffic accidents, conscious infants should be left in their rigid seat or capsule until assessed by ambulance personnel. If possible, remove the infant seat or capsule from the car with the infant/child in it. Children under eight years of age may require padding under their shoulders (approximately 2.5cm) for neutral spinal alignment.
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