Spinal Immobilization Selective Spinal Immobilization North Central Regional

Spinal Immobilization & Selective Spinal Immobilization North Central Regional Trauma Advisory Council 2009

Introduction

Objectives n n Review proper spinal immobilization procedure Discuss the side effects and risks of spinal immobilization. Learn the proper application of a selective spinal immobilization protocol including exclusionary criteria. Learn the components of the selective spinal immobilization protocol physical examination.

Manual Immobilization

C-Collars

Proper Sizing

Levitate to the Board !! n Which is best? Roll or lift? n Roll with arm up or down? n What if they have an injury on a particular side? n Scoop?

Strapping Technique n Very little published on techniques n Many services use 3 straps – Nipple line, pelvis and knee areas n Other strap suggestions – 2 crossed over chest – 1 across abdomen – Above and below knees

Strapping Technique

State of WI Procedure n Continue manual head stabilization n Secure pt at chest, hips, thighs and below knees n Secure head to board n Pad as needed to maintain neutral alignment

Selective Spinal Protocol

Complications Mediccast. com

Protocol development

NEXUS n n n Midline cervical tenderness Altered level of consciousness Evidence of intoxication Neurologic abnormality Presence of distracting injury

Canadian C-Spine Study

Maine Experience

Protocol Use

Ability to Communicate n Unable to speak English n Developmentally disabled n Intoxicated n Acute anxiety reaction

Level of consciousness

Distracting Injury

Extremes of Age

Components of a Protocol n n n A positive or uncertain mechanism for spinal cord injury, An awake and reliable patient that has, A normal motor skill exam, A normal sensory skill exam, No spine pain or tenderness And no extremity numbness or tingling.

Mechanism of Injury n Violent impact to the head, neck, torso, or pelvis… n Incidents producing sudden acceleration, deceleration, or lateral bending forces to the neck or torso n Any fall, especially in elderly persons, n Ejection or fall from any motorized or otherwise-powered transportation device, n Victim of shallow-water diving incident. PHTLS 6 th Ed.

Mechanism of Injury

Physical Assessment

Cervical Spine Palpation

Motor Assessment

Sensory Assessment

Motor Assessment

Range of Motion

To Pass Exam n The patient must: – Be awake and reliable – Have no spine pain or tenderness – Have no numbness or tingling – Have a normal neurological exam

Not Passing Exam n Failure to meet any one (or more) of the preceding criteria n May indicate a spine or spinal chord injury and more assessment at the hospital is necessary

Documentation n Document absence of all exclusionary criteria n Document all portions of the exam

Education This session does not take the place of full selective spinal immobilization training which should include classroom discussion, demonstration, practice and testing.

Medical Direction

Quality Assurance n Chart review n Refresher training n Competency testing n Field supervision

Questions? ? ?