Unit Spinal Injuries by liaoqinmei

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									Unit 10 Spinal Injuries
Primary survey of injury
   Exam to determine the presence of any life
    threatening emergencies
       Check for alertness and orientation by talking to the
        individual
   Assessment of ABC’s
       Airway – head and chin tilt, finger sweep, face mask
        removal
       Breathing – look, listen and feel
       Circulation - pulse
Primary survey
   Unconscious patient –
    treat as if the patient
    has a spinal injury
   Do not move the head
    or neck!
   Do not remove
    helmets, cut facemask
    with trainer’s angel
   Use log roll method
    stabilizing head and
    neck
Secondary survey

   Head to toe exam to determine extent of injury
       Determines if patient leaves field on their own, with
        assistance or with ems
   See pg 9-16
   Use to determine mechanism of injury and gain
    history of patient
   Talk to patient
       Checks for orientation
       Calms patient
   Isolated injury assessment – specific body part, you
    saw the injury occur
    Moving an athlete
   Give emergency first aid before moving
   If there are symptoms of head or spinal
    injury, do not move and protect head
    and neck until EMS arrives
       If patient is not breathing, log roll and begin
        CPR
   If no neck or spinal problems, assist to
    sitting position then to standing
       Look for dizziness or faintness at each
        position
    Basic Life Support (13)
   CPR – cardiopulmonary resuscitation
       Combines rescue breathing and chest
        compressions to keep the blood circulating
        and lungs filled with oxygen
       Immediate recognition and response is
        key!!!
   Respiratory arrest – not breathing, no
    way for body to get oxygen
   Cardiac arrest – no heart beat
   Full arrest – no heartbeat and not
    breathing
       Body can survive a short time (4-6)
        minutes before biological death occurs
    Steps of life support
   Determine responsiveness
     “are you okay”, no response = 911

   Assess Breathing
     Should be flat on back

     Open airway with head-tilt/chin-lift

     In case of spinal injury use jaw-thrust
           Hands on each side of jaw and lift forward
       Look, listen and feel 3-5 seconds
           If not breathing = 2 rescue breaths
   Assess Circulation – carotid pulse, no pulse
    start compressions
   Cpr – 4 cycles of 30 compressions to 2
    breaths every 2 minutes
3 Person Log roll
   Used to turn over a patient who is lying face down
    without causing additional injury (13-11)
   R1 –kneel and stabilize patients head
       Place hands on side of head (fingers pointing to the
        ground), cross wrists
   R2 – Kneel at patients waist
       Straighten arms and legs
       Extend arm nearest to you over patients head, next to ear
   R3 – kneel at patients knees
       Keep legs together and straight
Anatomy of the spine
   More complex than other
    joints
   Protects spinal cord
   Most injuries in cervical
    and lumbar regions
   Injuries can be life
    threatening
   Supported by muscles
    and ligaments
Anatomy
   Structure of bones with 4 segments
    with normal curvatures in each
    segment
       Sacrum – tailbone
       Lumbar – lower spine
       Thoracic – middle spine
       Cervical – upper spine
   Bones (vertebrae) are separated by
    disks, held together by ligaments
       7 cervical
       12 thoracic
       5 lumbar
       5 sacral (fused together)
       Each vertebra has a body, spinous process,
        and canal for spinal cord
Intervertebral disks
   Lie b/n vertebrae
   Absorbs shock and resists
    compression
   Keeps vertebrae separate, allowing
    movement and flexibility
   Gives space for nerves to exit spinal
    cord
   Disks do not receive any blood
    supply so they don’t heal as well as
    other tissues
   2 parts of the disk
       Nucleus pulposus – jelly-like core
       Annulus fibrosus – layers of cartilage
        around core
    Muscles
   Attach to trunk and neck
    and extend to many parts
    of the body
   Provide wide range of
    movement and stability
   Like a mast on a ship
    (spine = mast, muscles =
    cables)
   Keeps body stable when
    it performs various tasks
   See muscles of the back
    diagram
    Posture
   Normal – lateral view – straight line passes
    down just behind ear, through center of
    shoulder, down through middle of hip, just
    behind patella, just in front of lateral malleolus
   Prevent poor posture by:
     Pulling head up straight

     Exercise regularly

     Alternate which shoulder you carry bags on

   Abnormal – interferes with spines ability to
    absorb shock, which can lead to injury
     Kyphosis – excessive roundedness of thoracic
      spine (shoulders)
     Lordosis – too much forward curve in lumbar
      spine
     Scoliosis – bending side to side of spine
      (should be straight from skull to sacrum)
Preventing Spinal Injuries
   Participate in exercise and flexibility
    programs
       Necessary to maintain muscles
        surrounding spine
       Key spots: abdomen, hip muscles
   Maintain proper posture
   Lift properly
       Lift with knees and hips while keeping
        slight curve in lumbar region, keep head
        up
       Back supports
    Lumbar Ligament injuries
   Lumbar sprains – from excessive
    trunk flexion, rotation i.e. football
    player being tackled
       Vertabral joints separate and stretch
        out ligaments
   Localized pain on one side of spine
    with limited movement and muscle
    spasm
   Stress test – gently push each
    vertebra anteriorly, if pain = sprain
    ligament
   Treat with PRICE and active rest
Muscle and tendon injuries
   Rarely ruptures but mild and
    moderate strains are common
   Pain to one side of spine, muscle
    spasms, and limited movement
       Pain often on opposite side of bending
       Pain moves up and down length of
        muscle
   Treat with ice and gentle stretching
    then move on to strengthening and
    stretching routines
   Check posture and lifting techniques
    to avoid reinjury
Bone Injuries
   Can occur in lumbar
    region, usually from severe
    compression (like land
    hard on the buttocks)
   Need to be x-rayed to be
    sure
   Great deal of back pain,
    muscle spasm, and
    tenderness touching the
    vertebrae
   Treat conservatively –
    backboard, ems, hospital
    Other common injuries
   Lumbar disk bulge (aka slipped disk) –
    common in older athletes
       Disk does not move backward or forward
       Jelly-like nucleus pulposus presses through
        rings of cartilage
       Bulge usually occurs on posterior side of
        spine
       can press on nerves leaving spinal cord
        causing numbness, tingling and pain down
        the leg, pain in lower back that gets worse
        when sitting
       Treated by teaching proper posture,
        mechanics, sometimes traction to reduce
        the bulge
Bulging disk on left
    Cervical Spine Injuries
   Ligament sprains – result of
    hyperextension or hyperflexion of
    the neck – (whiplash)
       Neck and arm pain
       All neck trauma should be thoroughly
        evaluated by ATC to rule out spinal
        cord injuries
       Treat with price but no compression
        of the neck – don’t want to interfere
        with blood flow to the brain
       Neck brace can be used for support
       See Dr.
       Rehab to regain full strength and
        ROM
   Muscle and tendon
    injuries (whiplash)
       Symptoms – muscle
        spasms, restricted ROM,
        weakness against
        resistance, pain and
        muslce tenderness
       Same treatment and
        rehab as with ligament
        sprains
   Bone injuries – include fractures and dislocations,
    can cause devastating results and even death
       Fractures – result of an axial load – neck is lowered and
        spine straightens and a force is applied to the head
       Dislocations – result from excessive flexion and rotation
   Signs and symptoms- pain around cervical spine,
    weakness, numbness and tingling down arms
   Treatment – 911, rule out life threatning conditions,
    immobilize neck and backboard the athlete, do not
    remove helmet
    Other common cervical spine injuries
   Disk injuries – not as common as lumbar
     Disk bulge – more pain while seated or flexing
       neck than while standing or walking, pain and
       discomfort between shoulder blades
     Treatment – work on neck posture, neck
       extension exercises that don’t aggravate the
       condition
     Any numbness or tingling, see DR

   Brachial Plexus – network of nerves that exits
    cervical spine and runs through shoulders and
    down arms
   Stretching the BP causes burning, tingling,
    numbness and stinging sensations in the arm
    and shoulder (aka “stinger”)
     Usually in football

     Prevent with neck roll pads

     Can last seconds to minutes to weeks

								
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