Transcript Spinal immobilisation and extrication

•Estimated that 3% to 25% of spinal cord injuries occur after initial traumatic insult
•During 1970’s 55% of patients had complete neurologic lesions
•During 1980’s 61% of patients had incomplete neurologic injuries
•All patients with potential spinal injury after trauma
•1989 Garfin stated ‘no patient should be extricated from a crashed vehicle or
transported from an accident scene without spinal immobilization’
•Decline in percentage of complete SCI from 1970’s to 39% in 1980’s
1. A hard backboard
2. Rigid cervical collar
3. Lateral support devices
4. Tape or straps to secure everything in place
•Comparative studies with various devices done on healthy volunteers
•Methods used to assess spine motion include X-Ray, CT, MRI, plumb lines, cinematog
•All patients’ should have their c-spine placed in neutral position
•Except
if pt is conscious – and there is pain upon starting movement
– pt holds head in angulated position and states they are
unable to move it
if pt unconscious – severe muscle spasm upon attempting maneuver
space limitations
•Schreiger
– the normal anatomic position of the head and torso one assumes
when standing and looking ahead
•12 degrees of cervical spine extension on lateral X-Ray
•De Lorenzo
– MRI showed flexion equivalent to 2cm occipital elevation
– produces favorable increase in spinal canal / spinal cord ratio C5/C6
•McSwain
– Arnold Schwarzenegger vs. Laverne
•Backboard
•Cervical collar
– soft collar to keep necks warm
– rigid collar affords no protection on its own
•Sandbags
– in combination with cervical collar offers superior c-spine protection
– reduces neck extension from 15 to 7,4 degrees (Podolsky et al)
– tad heavy and if falls on tilting can pull pt’s head with it
•Spider harness – Perry et al observed that efficacy of c-spine immobilization limited
unless torso strapped (studies by Mazolewski affirming statement)
•Logroll
– still have movement at lumbar spine
•Haines maneuver
•Fireman’s lift
•We’ve got no evidence that c-spine immobilization is necessary in all patients
•Who do we apply it to and what guidelines are there
•What are the dangers of spinal immobilization
•We’ve got no evidence that c-spine immobilization is necessary in all patients
•Who do we apply it to and what guidelines are there
•What are the dangers of spinal immobilization
•Pain
– common among all patients restrained
– can be improved with use of vacuum splint mattress
An Neann Vacmat Vacuum Mattress for the transportation of trauma patients over long distances.
The splint is made up of a tuff tarp type outer skin filled with tiny balls about 1 mm in diameter.
The mattress is placed under the patient and then air is sucked out of the splint to form a rock hard device preventing body movement.
The mattress is used for patients being transferred with spine, pelvic and leg injuries.
•Raised ICP
– Davies (Injury 1996) demonstrated 4mmHg rise in ICP
– Hunt (Anaesthesia 2001) greater rise in pt with ICP > 15mmHg
due to decreased venous return
•Pressure sores – pt’s not turned in first two hours (Linares)
– duration on spine board significantly associated with decube ulcer
•Marginal mandibular nerve palsy
•Aspiration
•Decreased respiratory function
– Bauer et al and Totten et al demonstrated a 15% decrease in
overall pulmonary function (FEV1, FVC, FEV1:FVC, PEF)