Transcript National Surf Safety Report

Spinal Management
Certificate
Version: 3.0 010908
Housekeeping
Course
Timings &
Breaks
Facilities
Phones/ Pagers
Exits
Assembly Point
Version: 3.0 010908
Resources
•
•
•
•
PowerPoint Handout
Spinal Management Learner Guide
Assessment Activity Booklet
Facilitator Guide
Version: 3.0 010908
Learning Outcomes
• Hold a basic understanding of spinal cord anatomy and
injuries
• Describe the possible causes of spinal injuries
• Detail the signs and symptoms of a patient with
suspected spinal injuries
• Detail the principles of immobilisation for spinal injuries
• Detail and demonstrate the management of head and
spinal injuries
• Demonstrate how to move a casualty with suspected
spinal injuries
Version: 3.0 010908
Introduction
This non-accredited course is designed to link existing
knowledge with more detailed information so best
practice spinal management techniques are achieved in
your workplace
The information given:
• Focuses on principles of good spinal care in an
emergency situation
• Provides a range of management options
• Enables the learner to develop individual management
plan specific to each incident
• Allows for organisational practices to be included
• Draws on trained and untrained rescuers
Version: 3.0 010908
Spinal cord injury
• SLSA recorded 158 suspected spinal injuries
between August 2006 and July 2007.
• Each year 50 people are injured in diving
accidents in Australia.
• Average cost to support a person who has
sustained a major spinal injury is over
$1,250,000 per person.
Version: 3.0 010908
SPINAL CORD INJURY
SCI Classifications
• Traumatic – resulting from an external causes
• Non-traumatic – caused by medical conditions
Version: 3.0 010908
SCI Treatment Centres
Australia has 6 hospitals that care for SCI patients.
They are located in the following 5 states.
QLD – Princess Alexandra Hospital
NSW – Royal North Shore Hospital & St James
Hospital
VIC – Austin Hospital
SA – Royal Adelaide Hospital
WA – Royal Perth Rehabilitation Hospital
Tasmania, NT and the ACT do not have Spinal Units,
patients are sent to the nearest interstate Spinal Unit.
Version: 3.0 010908
Spine & Nervous System
Spine 42 cm long
33 vertebrae
Allows movement,
twisting and
bending of the
spine
Natural ‘S’ curve
Version: 3.0 010908
Spinal column
• Vertebrae
– Protects spinal cord
– Provides support to the body
– Outer section bony mass offers point of
attachment
– Inner hollow provides a passageway for spinal
cord to run through
• Cerebrospinal fluid (CSF) acts as cushion
against injury
• 31 spinal nerves running from spinal column
communicate with whole body
Version: 3.0 010908
Nervous system
Divides into two parts
• Central Nervous System (CNS)
– Dorsal cavity
– Cranial subcavity
– Spinal cavity
• Peripheral Nervous System (PNS)
– Somatic nervous system
– Sympathetic nervous system
– Parasympathetic nervous system
Version: 3.0 010908
Mechanisms of injury
• MOI is the exchange of forces that results in an injury.
Version: 3.0 010908
5 Mechanisms of SCI
•
•
•
•
•
Hyperextension
Hyperflexion
Compression
Distraction
Rotation
Version: 3.0 010908
5 Mechanisms of SCI
• Hyperextension
– Spine arched backwards
beyond normal limits
– Type of injury most
commonly in the upper
cervical section of spinal
cord
– Common causes are motor
vehicle accidents and
shallow water diving
accidents
Version: 3.0 010908
5 Mechanisms of SCI
• Hyperflexion
– Spine arched forwards
beyond normal limits
– Type of injury most
commonly in the upper
cervical section of spinal
cord
– Common causes are
whiplash or falling down
stairs.
Version: 3.0 010908
5 Mechanisms of SCI
• Compression
– Spinal cord is compressed
– Commonly results in injuries
to C5-6 and T12-L1
– Common causes diving
injuries and impacting
windscreens in motor
vehicle accidents
Version: 3.0 010908
5 Mechanisms of SCI
• Distraction
– Overstretching of the spinal cord
– Caused by hanging injuries or playground injuries to children
Version: 3.0 010908
5 Mechanisms of SCI
• Rotation
– Head and body rotate in
opposite directions
– Common causes are motor
vehicle accidents and if
ejected from the vehicle
Version: 3.0 010908
Common causes of SCI
•
•
•
•
•
•
•
motor vehicle accident
industrial accident (workplace)
diving accident
sporting accident
a fall from a height
a significant blow to the head
severe penetrating wounds (i.e. gunshot)
SLSA/ALA v1.0 Apr 2008
Version: 3.0 010908
SCI Types of injury
Tetraplegia or (Quadriplegia):
– ‘Paralysis of four limbs’
– Impairment or loss of motor or sensory function in the cervical
segments of the spinal cord.
– At this level, arms and legs are affected
Paraplegia:
– Paralysis of both lower extremities
– Impairment or loss of motor or sensory function in the thoracic,
lumbar or sacral segments of the spinal cord.
– At this level, the SCI patient will still have arm function
Version: 3.0 010908
Signs & symptoms
Signs
Breathing difficulties*
Loss of consciousness or fading in &
out*
Loss of function in hands, fingers, feet
or toes*
Loss of bladder or bowel control*
Neck or head in abnormal position*
Dilated pupils
Fluid leaking from the ears
Abnormal blood pressure
Profuse bleeding from the head
Abrasions or bruising to the head or
forehead
Shock
Symptoms
Back or neck pain (intense*)
Tingling or lack of feeling in
lower or upper limbs
Increased muscle tone
Headache or dizziness
Version: 3.0 010908
Secondary injury
First responders prevent further injury through the
application of sound incident management practices; i.e.
•
•
•
•
Preventing further movement
Oxygen therapy
Correctly preparing patient for transportation
Accurately record the patient’s vital signs, incident
details and provide first aid
• Treat patient for shock
Version: 3.0 010908
How to classify SCI?
Complete Injuries:
Complete SCI are total loss of motor function (paralysis)
and sensory perception is a result of interruption of
the ascending and descending nerve tracts in the
spinal cord.
Incomplete Injuries:
There is some function below the level of SCI
67% of SCI in Australia are incomplete
Poor management of the patient with incomplete SCI
can cause progressive worsening of spinal cord
function
Version: 3.0 010908
Special considerations
Padding under
• child or infant’s torso
• Biker’s torso
will assist in aligning
patient’s head to the
neutral position
Version: 3.0 010908
Primary survey – SCI patient
D – Danger
R – Response
A – Airway management and cervical spine stabilization
B – Breathing (ventilation)
C – Circulation and bleeding
D – Defibrillation
Version: 3.0 010908
Check for contraindications
Conscious patient
• Patient’s head or part of their
torso is tilted and the patient is
unable to move from that
position
• Moving the patient’s head or
spine can not be performed
because of space limitations or
other conditions.
• Airway obstruction
• Breathing Difficulties
Unconscious patient
• Not Breathing
• Moving the patient’s head or
spine can not be performed
because of space limitations or
other conditions.
• Airway obstructions
Where a contraindication becomes evidence STOP the course of action
immediately and immobilise the patient as is.
Version: 3.0 010908
Remove motorcycle helmet?
Reasons that it may be necessary to take off a casualty’s
helmet at the scene of the accident include:
• to obtain a clear airway (conscious or unconscious
patient)
• for oxygen therapy to be administered
• to apply a cervical collar
• to place the patient’s head into a neutral position, as the
helmet has lifted the head into hyperflexion.
Version: 3.0 010908
Learning task one
Complete learning task one on page 28.
Version: 3.0 010908
Types of spinal immobilisation &
retrieval equipment
Step 1
• minimise further movement of patient’s head by using – manual stabilisation – standing or supine
– vice grip.
Step 2
• Fit cervical collar
Step 3
• Utilise lifting and carrying devices
Version: 3.0 010908
Types of spinal immobilisation &
retrieval equipment
•
•
•
•
•
•
Head block
Immobilisation strapping
Spine board (long spine board or backboard)
Scoop stretcher
Stokes basket
Extrication device & stretchers
SLSA/ALA v1.0 Apr 2008
Version: 3.0 010908
Types of spinal immobilisation &
retrieval equipment
See Learners Manual
pages 29 to 38.
Version: 3.0 010908
Learning task two
Complete learning task two on page 35.
Version: 3.0 010908
Cervical collar
• Applied by trained and experienced personnel only
• Check manufacturer’s fitting instructions
• Ideally two people to fit collar
– Rescuer one performing manual stabilisation
– Rescuer two fits collar
• Communicating your actions with the conscious patient
is critical.
Manual stabilisation must continue after the fitting of the cervical collar.
Version: 3.0 010908
Cervical collar - supine patient
The same steps apply as for a standing or seated patient.
Except, fold in Velcro fasteners to protect from contamination by sand
or gravel.
Version: 3.0 010908
Learning task three
Complete learning task three on page 39.
Version: 3.0 010908
Safe transportation of a patient
Australian Resuscitation Council advise that an injured or
unconscious patient’s condition can be worsened by
movement.
If movement is necessary of a conscious patient, extreme
care must be taken to minimise movement of the spine
in any direction, and the painful area must be fully
supported.
Airway management takes precedence over any suspected
spinal injury in an unconscious patient
Guideline 8.18 www.resus.org.au
Version: 3.0 010908
Log roll
Cervical collar fitted first
Accepted method to
position a patient on
their side
Allows for placement of
blanket, board or litter
against spine
Positions patient’s arms
down either side of torso
Supports thoracic/lumbar
area against sagging
Version: 3.0 010908
Backboard sitting patient
Cervical collar fitted first
Allows for minimal
movement to patient’s
spinal column
Minimum 3 people to
perform this technique
Back board lowered to
ground
Patient is slid along board
in 30 cm increments to
correct position
Version: 3.0 010908
Aquatic rescue (pool or still water)
Rescuer to move cautiously towards patient
Minimise water movement around patient
Stabilise patient’s head using either
• Vice grip technique
• Extended arm roll-over technique (surf retrieval)
• Fit cervical collar
Version: 3.0 010908
Trapezius grip
The trapezius grip is used to support the patient’s head and
neck, whilst allowing the fitting of a cervical collar.
• Grip upper trapezius muscle between thumb and the
fingers, supporting the head between the forearms (held
vice-like along side of head)
• To allow for the cervical collar to be fitted, the rescuer
grips the trapezius muscle between the extended middle
and ring fingers (forming a V-shape).
• The forearms continue to provide firm support to the
head
See Learners Manual p.65
Version: 3.0 010908
Learning task four
Complete learning task four on page 69 to 71.
Version: 3.0 010908
Preparing patient for transport
• Immobilisation strapping is fitted before moving the
patient from the water.
• Chest strap is secured first, followed by hip or feet (see
manufacturer’s guidelines) and finally the head strap is
applied.
• Manual stabilisation continues at all times until handover
• Reassure the conscious patient continually
• Monitor patient’s body temperature (shock to nervous
system affects ability to self-regulate)
• Protect patient from elements; sun to eyes, wind on
body, etc.
Version: 3.0 010908
Version: 3.0 010908
Preparing patient for transport
Key considerations when moving the patient on a spinal
board.
• Always move patient in head first direction
• Avoid lifting one end of the board higher than the other –
keep horizontal, or head higher on stairs
• Do not slide spine board across the ground or surface, it
may catch and jerk or jolt the patient
• Ensure hair, jewellery and clothing is clear and can not
catch against surfaces or become caught in the rescuers
hands, straps, etc.
Version: 3.0 010908
OHS considerations
Observe OHS recommendations when lifting patient from
ground level use a minimum of 4 people to lift.
Version: 3.0 010908
Learning task five
Complete learning task five on page 56.
Version: 3.0 010908
Practical demonstration
Now move to the pool or a still water environment to
practice your spinal management techniques.
Version: 3.0 010908
Assessment
Assessment is complete when you have:
• Demonstrated spinal management and patient removal
techniques in an still-water aquatic environment
• Answered the questions and handed-in the Learner
Assessment Activity to your assessor for marking.
Version: 3.0 010908