Neck & Back injuries. C3-5 keep the diaphragm alive Head is heavy Physiology.
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Transcript of Neck & Back injuries. C3-5 keep the diaphragm alive Head is heavy Physiology.
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Neck & Back injuries
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C3-5 keep the diaphragm alive
Head is heavy
Physiology
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Mechanism Of Injury (speed/force, direction)
Get as much info as possible! (Bystanders?) – pass onto crew
Lateral forces more damaging
50% to cervical region – very delicate
Injury
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Danger – traffic, people, animals Response – AVPU (think about where you stand when
talking) Summon help! Airway (& C-spine) Breathing Circulation Dysfunction Exposure
Assessment (Primary Survey!!)
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To immobilise or not to immobilise If M.O.I suggests immobilise, do it.
Airway (& C-spine)
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Neutral alignment (adults / children) What if there’s pain / resistance?
How do we open the airway??
Airway (& C-spine) - Immobilised
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Jaw thrust (2 movements) – why? (Avoid causing axial pressure)
What if jaw thrust doesn’t work??
Airway (& C-spine) – Jaw Thrust
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Are they breathing?? Rate, ease, depth, regularity (might be
affected by spinal cord injury)
Breathing
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Neurogenic shock → slow pulse & low BP Changes in skin colour
Circulation
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Look Feel (Move)
Dysfunction: Assessment• Pain• Tenderness• Irregularity
• Sensation• Pins &
needles• MovementKeep Pt calm!!
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Priaprism
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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)
Management
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To immobilise or not to immobilise? What influences this?
Airway (& C-spine)
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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
C-spine Clearing 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?
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Scenarios
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http://www2.warwick.ac.uk/fac/med/research/hsri/emergencycare/prehospitalcare/jrcalcstakeholderwebsite/guidelines/clinical_guidelines_2006.pdf
If you’re bored…