Neck Spinal Injuries Neck and Spinal Injuries St

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Neck & Spinal Injuries

Neck & Spinal Injuries

Neck and Spinal Injuries • St John (NSW) frequently covers events where spinal injuries

Neck and Spinal Injuries • St John (NSW) frequently covers events where spinal injuries are possible. • These events include contact sports, equestrian events, Go Karts and surf carnivals etc…. . 14 January 2022 Coffs Harbour Divisional Training 2

Spinal injuries can however occur at any event! 14 January 2022 Coffs Harbour Divisional

Spinal injuries can however occur at any event! 14 January 2022 Coffs Harbour Divisional Training 3

Neck and Spinal Injuries • All First Responders and Advanced Responders require skills in

Neck and Spinal Injuries • All First Responders and Advanced Responders require skills in spinal precautions, including the application of a semi-rigid cervical collar. • Cervical collars must be regarded as standard equipment required for any duty. 14 January 2022 Coffs Harbour Divisional Training 4

Neck and Spinal Injuries • A spinal cord injury can be particularly traumatic, because

Neck and Spinal Injuries • A spinal cord injury can be particularly traumatic, because the resulting damage may be permanent. • They are always serious and must be treated with great care. 14 January 2022 Coffs Harbour Divisional Training 5

Neck and Spinal Injuries • Incorrect handling can result in paralysis. • Careful assessment

Neck and Spinal Injuries • Incorrect handling can result in paralysis. • Careful assessment and management will help minimise permanent disability and increase the potential for recovery. 14 January 2022 Coffs Harbour Divisional Training 6

Neck and Spinal Injuries If the spinal cord is damaged, no messages will be

Neck and Spinal Injuries If the spinal cord is damaged, no messages will be received by the brain or sent to that part of the body below the injury 14 January 2022 Coffs Harbour Divisional Training 7

Neck and Spinal Injuries The control centers for breathing and heart are in the

Neck and Spinal Injuries The control centers for breathing and heart are in the lower parts of the brain. 14 January 2022 Coffs Harbour Divisional Training 8

Neck and Spinal Injuries Death may result if these vital cell groups are damaged

Neck and Spinal Injuries Death may result if these vital cell groups are damaged or their message cannot pass an injured section of the spinal cord. 14 January 2022 Coffs Harbour Divisional Training 9

Neck and Spinal Injuries 14 January 2022 10

Neck and Spinal Injuries 14 January 2022 10

Neck and Spinal Injuries The spinal cord inside C 3, C 4 and C

Neck and Spinal Injuries The spinal cord inside C 3, C 4 and C 5 control the autonomous nervous system. 14 January 2022 Coffs Harbour Divisional Training 11

Neck and Spinal Injuries ‘Three, four and five keep a man alive’ ‘Three four

Neck and Spinal Injuries ‘Three, four and five keep a man alive’ ‘Three four and five keeps the diaphragm alive’ 14 January 2022 Coffs Harbour Divisional Training 12

Neck and Spinal Injuries Without the control at this level, normal impulses such as

Neck and Spinal Injuries Without the control at this level, normal impulses such as breathing are not performed by the body. 14 January 2022 Coffs Harbour Divisional Training 13

Neck and Spinal Injuries Christopher Reeve was able to survive a break in that

Neck and Spinal Injuries Christopher Reeve was able to survive a break in that area, because he received immediate medical assistance, including ventilation to sustain his oxygen levels. 14 January 2022 Coffs Harbour Divisional Training 14

Because of the energy required to cause these spinal fractures, patients often have additional

Because of the energy required to cause these spinal fractures, patients often have additional injuries that require treatment! 14 January 2022 Coffs Harbour Divisional Training 15

Neck and Spinal Injuries Men experience fractures of the thoracic or lumbar spine four

Neck and Spinal Injuries Men experience fractures of the thoracic or lumbar spine four (4) times more often than women. 14 January 2022 Coffs Harbour Divisional Training 16

Neck and Spinal Injuries Seniors are also at risk for these fractures, due to

Neck and Spinal Injuries Seniors are also at risk for these fractures, due to weakened bones from osteoporosis 14 January 2022 Coffs Harbour Divisional Training 17

Signs & Symptoms • Pain at or below site of injury • Tenderness over

Signs & Symptoms • Pain at or below site of injury • Tenderness over site of injury • Absent or altered sensation below the site of the injury (e. g. tingling in hands or feet) • Loss of movement or impaired movement below the site of injury 14 January 2022 18

Signs & Symptoms • • • 14 January 2022 Shock Breathing difficulties Head or

Signs & Symptoms • • • 14 January 2022 Shock Breathing difficulties Head or neck in an abnormal position Nausea, headache or dizziness Loss of bladder or bowel control Priapism (erection in males) 19

Signs & Symptoms • Tell the victim to remain still but DO NOT physically

Signs & Symptoms • Tell the victim to remain still but DO NOT physically restrain if uncooperative. • Patients with significant spinal pain will likely have muscle spasm which acts to splint their injury. • Try to keep them comfortable until help arrives. 14 January 2022 20

Signs & Symptoms • It is important to realise that people with a neck

Signs & Symptoms • It is important to realise that people with a neck or spinal injury don’t always ‘show’ signs or symptoms. • Often you need to make a decision on their management based on the ‘mechanism of injury’. 14 January 2022 21

Management Conscious • Follow DRSAB(CD) • Unless they’re in danger DO NOT move them.

Management Conscious • Follow DRSAB(CD) • Unless they’re in danger DO NOT move them. Tell them to remain still. • Assess patient and find out what happened? Make a decision. • Call 000 (ask someone) • Calm the patient talking to them without their head having to move 14 January 2022 Coffs Harbour Divisional Training 22

Management Conscious Support head and neck by placing hands on either side of patient’s

Management Conscious Support head and neck by placing hands on either side of patient’s head until other support is arranged (ask someone). 14 January 2022 Coffs Harbour Divisional Training 23

Management Conscious Apply a cervical collar and sand bags either side of head 14

Management Conscious Apply a cervical collar and sand bags either side of head 14 January 2022 Coffs Harbour Divisional Training 24

Management Conscious • Administer oxygen therapy at 8 – 15 LPM via Hudson Mask

Management Conscious • Administer oxygen therapy at 8 – 15 LPM via Hudson Mask (Therapy) • Maintain body temperature 14 January 2022 Coffs Harbour Divisional Training 25

Management Conscious • Complete a patient Report (OB 12) • Handover to Ambulance Paramedics

Management Conscious • Complete a patient Report (OB 12) • Handover to Ambulance Paramedics 14 January 2022 Coffs Harbour Divisional Training 26

Management Unconscious (breathing) • Follow DRSABCD (Call 000) • Apply Cervical Collar • Place

Management Unconscious (breathing) • Follow DRSABCD (Call 000) • Apply Cervical Collar • Place in recovery position (log roll – towel/sand bags) • Maintain a clear and open airway Remember if the patient is unconscious airway and breathing always takes precedence 14 January 2022 Coffs Harbour Divisional Training 27

Management Unconscious (breathing) • If the airway is not clear it is acceptable to

Management Unconscious (breathing) • If the airway is not clear it is acceptable to gently move the head into a neutral position to obtain a clear airway. • For example if the head was slumped forward (car accident) this would be a dangerous position to leave someone (asphyxia). 14 January 2022 Coffs Harbour Divisional Training 28

Management Unconscious (breathing) • In patients needing airway opening, use manoeuvres which are least

Management Unconscious (breathing) • In patients needing airway opening, use manoeuvres which are least likely to result in movement of the cervical spine. • Jaw thrust and chin lift should be tried before head tilt. 14 January 2022 Coffs Harbour Divisional Training 29

Management Unconscious (breathing) • Administer oxygen therapy at 8 – 15 LPM via Hudson

Management Unconscious (breathing) • Administer oxygen therapy at 8 – 15 LPM via Hudson Mask (Therapy) • Support head and spine with supports to prevent twisting or bending movements (towel/sand bags) 14 January 2022 Coffs Harbour Divisional Training 30

Management Unconscious (breathing) Maintain body temperature 14 January 2022 Coffs Harbour Divisional Training 31

Management Unconscious (breathing) Maintain body temperature 14 January 2022 Coffs Harbour Divisional Training 31

Management Unconscious (breathing) • Complete a patient Report (OB 12) • Handover to Ambulance

Management Unconscious (breathing) • Complete a patient Report (OB 12) • Handover to Ambulance Paramedics 14 January 2022 Coffs Harbour Divisional Training 32

Management Unconscious (not breathing) • Follow DRSABCD (Call 000) • Begin CPR and apply

Management Unconscious (not breathing) • Follow DRSABCD (Call 000) • Begin CPR and apply an AED immediately. • Oropharyngeal airway and introduce oxygen at 15 lpm to BVM 14 January 2022 Coffs Harbour Divisional Training 33

Management Unconscious (not breathing) • Complete a patient Report (OB 12) • Handover to

Management Unconscious (not breathing) • Complete a patient Report (OB 12) • Handover to Ambulance Paramedics 14 January 2022 Coffs Harbour Divisional Training 34

Use of Cervical Collars Purpose of Cervical Collars • Temporary support of the head

Use of Cervical Collars Purpose of Cervical Collars • Temporary support of the head of a sitting/standing patient • Minimises movement of spine during transport • Prevention of neck flexion/rotation • Highlights potential for spinal cord injury 14 January 2022 Coffs Harbour Divisional Training 35

Warning • Rigid collars alone DO NOT provide full spinal immobilisation. • Manual inline

Warning • Rigid collars alone DO NOT provide full spinal immobilisation. • Manual inline stabilisation must be maintained. 14 January 2022 Coffs Harbour Divisional Training 36

Warning • Spinal immobilisation is not without risk. • Complication may include head and

Warning • Spinal immobilisation is not without risk. • Complication may include head and neck pain, detrimental effects on pulmonary function and subsequent neurological deficits 14 January 2022 Coffs Harbour Divisional Training 37

Cervical Collar Immobilisation Indications Patients at risk for spinal injury Contraindications Penetrating neck injury

Cervical Collar Immobilisation Indications Patients at risk for spinal injury Contraindications Penetrating neck injury 14 January 2022 Coffs Harbour Divisional Training 38

Laerdal “Stifneck Select” 14 January 2022 Coffs Harbour Divisional Training 39

Laerdal “Stifneck Select” 14 January 2022 Coffs Harbour Divisional Training 39

Laerdal “Stifneck Select” • The preferred semi-rigid collar is the Stifneck® Select. TM from

Laerdal “Stifneck Select” • The preferred semi-rigid collar is the Stifneck® Select. TM from Laerdal. • Both the adult and paediatric Stifneck® Select. TM collars are to be carried. 14 January 2022 Coffs Harbour Divisional Training 40

Laerdal “Stifneck Select” • The adult Stifneck® Select. TM can be adjusted to 4

Laerdal “Stifneck Select” • The adult Stifneck® Select. TM can be adjusted to 4 sizes (tall, regular, short and no neck). • The paediatric Stifneck® Select. TM can be adjusted to 3 sizes. 14 January 2022 Coffs Harbour Divisional Training 41

Prepare the patient • Explain to the patient what you are doing and to

Prepare the patient • Explain to the patient what you are doing and to avoid head and body movement • Administer pain relief if required • Instruct someone to immobilise the head and neck with their hands • Carefully remove or rearrange patient’s clothing/jewellery 14 January 2022 Coffs Harbour Divisional Training 42

Sizing a Cervical Collar When fitting a cervical collar, measure the distance between the

Sizing a Cervical Collar When fitting a cervical collar, measure the distance between the jaw and the shoulder 14 January 2022 Coffs Harbour Divisional Training 43

Remember, it requires two people to put on a stifneck collar! 14 January 2022

Remember, it requires two people to put on a stifneck collar! 14 January 2022 Coffs Harbour Divisional Training 44

Application for Supine Patient • • 14 January 2022 Slide back portion of collar

Application for Supine Patient • • 14 January 2022 Slide back portion of collar behind neck Once Velcro visible, position chin piece in circular motion, sliding chin section up chest to jaw Fasten Velcro & ensure a firm fit Re-tension if necessary Coffs Harbour Divisional Training 45

Practical Participants to practice applying cervical collars 14 January 2022 Coffs Harbour Divisional Training

Practical Participants to practice applying cervical collars 14 January 2022 Coffs Harbour Divisional Training 46

CP 2010 -02 Spinal immobilisation Once spinal precautions are applied by St John members,

CP 2010 -02 Spinal immobilisation Once spinal precautions are applied by St John members, these may only be removed by: • ASNSW paramedics • a medical practitioner 14 January 2022 Coffs Harbour Divisional Training 47

Spineboard? In rare situations, while waiting for an Ambulance, St John members have placed

Spineboard? In rare situations, while waiting for an Ambulance, St John members have placed a suspected spinal patient onto a spineboard and moved them. 14 January 2022 Coffs Harbour Divisional Training 48

Spineboard? • This is not the preferred procedure in treating a suspected spinal patient

Spineboard? • This is not the preferred procedure in treating a suspected spinal patient as it would lead to double handling of the patient. • Ultimately this decision would be based on what is best for the individual patient at the time. 14 January 2022 Coffs Harbour Divisional Training 49

Spineboard? Why move them? • Ambulance delayed • Safety of patient • Environment –

Spineboard? Why move them? • Ambulance delayed • Safety of patient • Environment – heat – rain – cold 14 January 2022 Coffs Harbour Divisional Training 50

Spineboard? • • Explain procedure to patient Apply a cervical collar (if not on

Spineboard? • • Explain procedure to patient Apply a cervical collar (if not on already) Member holds head in neutral position Roll patient towards you. 14 January 2022 Coffs Harbour Divisional Training 51

Spineboard? 14 January 2022 Coffs Harbour Divisional Training 52

Spineboard? 14 January 2022 Coffs Harbour Divisional Training 52

Spineboard? • Place board beside patient and slowly roll back onto board (sand bags)

Spineboard? • Place board beside patient and slowly roll back onto board (sand bags) • Secure the patient to board (straps) • Lift patient and board onto stretcher 14 January 2022 Coffs Harbour Divisional Training 53

Spineboard? • Patients should NOT be left on rigid spineboard! • May develop pain

Spineboard? • Patients should NOT be left on rigid spineboard! • May develop pain in the neck, back of the head, shoulder blades and lower back. 14 January 2022 Coffs Harbour Divisional Training 54

Spineboard? Also the patient may attempt to move around in an effort to improve

Spineboard? Also the patient may attempt to move around in an effort to improve comfort, potentially worsening their injury. 14 January 2022 Coffs Harbour Divisional Training 55

Questions 14 January 2022 Coffs Harbour Divisional Training 56

Questions 14 January 2022 Coffs Harbour Divisional Training 56

BREAK 14 January 2022 Coffs Harbour Divisional Training 57

BREAK 14 January 2022 Coffs Harbour Divisional Training 57

Scenario At the half marathon, an organiser is up a ladder attempting to secure

Scenario At the half marathon, an organiser is up a ladder attempting to secure a loud speaker. A strong gust of wind hits the ladder and the organiser falls to the ground from around three metres. The impact is heavy as the patient lands on their back. 14 January 2022 Coffs Harbour Divisional Training 58

Scenario You and another member are notified of the fall and rush over to

Scenario You and another member are notified of the fall and rush over to the patient who is complaining of pain to their neck and tingling in their hands and feet. Demonstrate how you are going to manage this patient. 14 January 2022 Coffs Harbour Divisional Training 59

Management • Follow DRSAB(CD) • Unless they’re in danger DO NOT move them. Tell

Management • Follow DRSAB(CD) • Unless they’re in danger DO NOT move them. Tell them to remain still. • Assess patient and find out what happened? Make a decision. • Call 000 (ask someone) • Calm the patient talking to them without their head having to move 14 January 2022 Coffs Harbour Divisional Training 60

Management Support head and neck by placing hands on either side of patient’s head

Management Support head and neck by placing hands on either side of patient’s head until other support is arranged (ask someone). 14 January 2022 Coffs Harbour Divisional Training 61

Management Conscious Apply a cervical collar and sand bags either side of head 14

Management Conscious Apply a cervical collar and sand bags either side of head 14 January 2022 Coffs Harbour Divisional Training 62

Management Administer oxygen therapy at 8 – 15 LPM via Hudson Mask (Therapy) 14

Management Administer oxygen therapy at 8 – 15 LPM via Hudson Mask (Therapy) 14 January 2022 Coffs Harbour Divisional Training 63

Management • Complete a patient Report (OB 12) • Handover to Ambulance Paramedics 14

Management • Complete a patient Report (OB 12) • Handover to Ambulance Paramedics 14 January 2022 Coffs Harbour Divisional Training 64

Management Record history as described by the Patient using ‘what’, ‘how’, ‘when’ and where’

Management Record history as described by the Patient using ‘what’, ‘how’, ‘when’ and where’ questions. Patient complains of pain to their neck and tingling in their hands and feet. Patient states this was a result of falling from a ladder from a height of a round three (3) meters. Occurred at approximately 7: 00 hours at the Coffs Harbour Showground near the soccer fields.

Questions 14 January 2022 Coffs Harbour Divisional Training 66

Questions 14 January 2022 Coffs Harbour Divisional Training 66