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Neck & Back injuries

Neck & Back injuries. Physiology. 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. Pathophysiology. Mechanism Of Injury (speed/force, direction)

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Neck & Back injuries

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  1. Neck & Back injuries

  2. Physiology 33 in total

  3. Physiology C3-5 keep the diaphragm alive T attach to ribs (stronger) Which is weakest? (C? T? L?) Weakest during side-to-side movement

  4. Pathophysiology 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

  5. Assessment (Primary Survey!!) Danger – traffic, people, animals Response – AVPU (think about where you stand when talking) Summon help Airway (& C-spine) Breathing Circulation Dysfunction Exposure

  6. Airway (& C-spine) To immobilise or not to immobilise If M.O.I suggests immobilise, do it.

  7. Airway (& C-spine) - Immobilised • 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??

  8. Breathing Are they breathing?? Rate, ease, depth, regularity (might be affected by spinal cord injury)

  9. Circulation Neurogenic shock → slow pulse & low BP Changes in skin colour

  10. Dysfunction: Assessment • Pain • Tenderness • Irregularity • Sensation • Parasthesia? • Movement • Odd sensations Keep Pt calm!! Look Feel (Move)

  11. Priaprism

  12. Management 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)

  13. Airway (& C-spine) To immobilise or not to immobilise? What influences this?

  14. C-spineClearing 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? 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

  15. Scenarios

  16. If you’re bored… http://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/clinical_guidelines_2006.pdf

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