Spinal Immobilisation
Spinal immobilisation involves the use of a number of devices and
strategies to stabilise the spinal column after injury and thus prevent
spinal cord damage. This is widely used in trauma patients with
suspected spinal cord injury or patients involved in significant trauma
in the pre-hospital setting.
Manual in line protection should be instituted immediately. It is
often the case that more pressing needs over-ride immobilisation, like
airway management and profuse haemorrhage. The application of definitive
immobilisation techniques should not take precedence over life-saving
procedures.
If the neck is not in the neutral position, an attempt should be made
to achieve alignment. If the patient is awake and co-operative, and it
does not greatly increase pain, you should get them to actively move
their neck into line. If unconscious or unable to co-operate this is
done passively. If there is any neurological deterioration or resistance
to movement the procedure should be abandoned and the neck splinted in
the current position.
Rescue boards are the primary device used in extrication from
vehicles. Repeated transfers to and from the board may compromise spinal
protection and induce a significant amount of spinal movement. Recent
studies have shown that pressure sores can start to develop as little as
45 minutes from the time a patient is placed on a rescue board. If you use
this device as your primary immobilisation tool then bear this in
mind. It suggested that you note the time your patient is placed
on a rescue board so as hospital staff are better able to make an
assessment as to when it should be removed.
Tip!
Use oxygen at high flow with all patients you suspect of having a spinal
injury. Oxygen has been shown to reduce spinal cord oedema and so the
possibility of damage to the cord.
Tip!
Use two bags of 500ml saline as head immobilisers if you
haven't anything that will fit. This is especially handy for kids. Use
tape to strap across the forehead over the two bags of saline.
Tip!
Remember other injuries are very likely. If
a cervical spine fracture is found:
-
50%
have a fracture at an adjacent level. -
15%
have a fracture in another part of the cervical spine. -
10%
Have fractures in thoracic / lumbar spine.
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