PHTLS Ch10: Spinal Trauma

Physiology, lifestyle adn finanical circumstances

16-35 years of age

MVC
Falls

2nd is 21-25years of age
3rd is 26-35 years of age

16-20 years old

1) The head is like a bowling ball at the top of the neck. It moves in diffect directiosn from the torso

2) Objects in motion stay in motion

3) Sudden or violent movment of the upper legs moves the pelivs. Which moves the lower spine. Whcih caues movments of the upper spine

4) Lack of a nero deficts does not rule otu bone or ligament injuy to the spine

Any blut mechanism that would produce impact on head, neck, torso or pelivs

Sudden acceleration, deceleration, lateral bending to the neck/ torso

Falls

Ejection
Shallow water diving incident

33 bones called vertebrae

The anterior part called the body

It is the weight baring part of the vertebrate

Neural arches are the two curved spides of the vertebrae

spinous process is the posteriso part of the vertebra

Cervical, Thoracis, Lumbar, Sacral and coccygeal regions

Cervical-15%
thorac-15%
Thoracolumbar15%
Lumbosacral-15%

16-22lbs

Ascending and descending tracts

Carry sensory impulse from body parts through the cord up the brain

Tracts that carry differnt sensations of pain, temp. touch, pressure and motion viberation, postion and light toubh

Cross over. So left tract gets right body info.

Carry motor impulses from the brain throguh the cord down to the body. They also control all muslce movement and muscle tone

31

Dorsal-sensory impulses
Ventral-motor impulses

The sensory area on the body for which a nerve root is responsible

T4-nipple level
T10-is the umbilicus level

The pt will lose the ability to breath spontaneously.

1000lbs/ft

Compression fractures that prdouce wedge compression or total flattening of the vertebra

Fractures that produce small fragments of bone that may lie in the spinal cannel near the cord

Subluxation, partial dislocation of the vetebra from its normal alignmen tin the spinal column

Overstretching or tearing of th eligaments and muslce producing instability between the verebrate

10% chance

brusing or bleeding into the tissues of the spinal cord, Which may also resutl in tempoary loss of cord function distal to the injury

Penentratin type of injury or movement of bony fragments

Pressue on the spinal cord caused by swelling, But also may be from traumatic disc rupture and bone fragments

When the cord is cut

A complete break in the spinal cord

A half break of teh spinal cord

Anterior cord syndrome
Central cord syndrome
Brown-Sequard syndrome

Bony fragements or pressue on the spianl arteries

Loss of motor function, pain, temerature and light touch sensations.

Light touch, motion position and vibration sensatiosn are spared

Spinothalamic tract

usually occures with hyperextension of the cervical area

Weakness or paresthesia in the upper extremities but normal strengh in the lower extremities. Some bladder dysfunction

All of them-Pyramidal tract, Posetrior columnus and spinothalamic tract

Pain and tempreature sensation on th eopposite side

Motor function on the same side

Position and vibration sensation on the same side

Penetration injury and invovle hemi-transection of the cord

complete cord damage and loss of function on the affected side.

85-90mmHg

The pt is asked to move the arms, hands and legs. Any inability to do so is noted

Shoulders and down to the feet

Recongnize the indications for spinal immobilzation rather then attempt to clear the spine

Motor and sensory functions, Presnece of pain or tenderness and patient reiability as predictors of spinal cord injury

Superior assessment with appropriate and timely treatment

MVC, shallow water incidents
motorcyle crashes
Falls, Sport injuries

Falls from heights(2-3x the Pts height)
Falls from tricyle or bicyle
Being struck by Motor Vehicle

Any blunt mechanism, that produced a violent impact on the head, neck, torso or pelvis

Sudden accelerations, decelerations, or lateral bending on the neck or torso

All falls.

Ejection

Victim of a shallow water incident

Head Injs. with ALOC
Helmet Damage
Blunt inj to torso
Impacted or other deceleration fx of the legs and hips

Significat localized injuires to the area of the spinal column

If the Pt didn't sustain any neuo damage, nothing has happend

if the object didn't damage the cord, the pt probablly will not have any neuo damage

When it doubt-immobilize

ALOC,
Spinal pain or tenderness
Neuo defict or complaint
Anatomic deformity of the spine

Intoxication, Distracting painfull injuires, Communicatiosn barriers

Immoblize the pt to a supine position on a backbord in a neutral inline position

Fx managment-immobilizing the joint above and the joine below an inj.

Sitting, semi-prone, supine or standing

Resistance is noted
Neck muslce spasm
increased pain
Start or increase of Nero Defict such as numbness, tingling or loss of motor ability
Compromise of teh airway or ventilation

pts injuries are so sever that the head presents with such misalignment that it no longer appears to extent from the midline of the shoulders

Inadequate immobliation
Immoblization w. head hyperextended

Immobilizing teh head before the torso or eadjusting the torso straps after teh head has been seured

Inadequate padding

Move patients at little as possible. Movie pt after being secured to the backbord

Torso, head, legs, arms

Steroids-methylpredniscolne,
30mg/kg follwed by 5.4mg/kg/hr for up to 48hrs

Bradycardia

Presence of hypovoemic