Spinal and Pelvic injuries

What are the dangers of pelvic injuries?

• More likely to fracture in more than one place

• Large vasculature in area, can hold up to 5l of blood

• Can cause damage to other organs in abdomen

What are some causes of pelvic injuries?

• High energy transfer e.g. RTC

• Fall from height

• Crush injury

• Elderly

• Degenerative bone diseases

• Receiving radiotherapy

What are signs and symptoms of pelvic injuries?

• Bruising

• Bleeding from rectum, vagina or urethra

• Deformity

• Swelling

• Shortening of lower limb

• Pain over hips, groin or lower back

• Hypovolemic shock

• Altered sensation in one leg

Describe management of pelvic injuries

Time critical- DRABC and splint

• Consider C-spine when managing airway

• Control catastrophic haemorrhage

• High flow O2 - increased demand for oxygen in tissues

• Pelvic splint - immobilise knees and ankles as well

• Minimise movement when treating - limit log roll to 10 degrees

• Consider paramedic assistance

• Pain relief

• Smooth rapid removal to MTC

• Full observation

• Avoid repeated movements and never ‘spring’

  • Put thumbs on iliac crest to see if equal

  • Once pelvic splint has been placed- do not remove

Describe how to put on a pelvic binder

• Can be used in conjunction with traction splint if concurrent mid-shaft femur fracture. However, Pelvic Splint goes on first as traction is pulling on pelvis.

Why is C-Spine so important?

• Controls respiratory and circulation centres

  • Remember - ‘C3, 4 and 5 keeps the diaphragm alive’

• Also the connecting point for all other bodily function and movement below it

What mechanisms of injury can injure the spine?

One or more of:

• Hyperflexion

• Hyperextension

• Rotation

• Compression

What are types of spinal injuries?

• Dislocation of vertebrae

• Fracture of vertebrae

• Displacement of vertebrae (prolapse)

Describe spinal shock

After a spinal cord injury:

• State of complete loss of motor function, even if spinal cord still intact

• Can have possible loss of sensory function

• Can go on for considerable time

• Recovery may occur

Describe neurogenic shock

After spinal cord injury:

• Poor tissue perfusion

• Caused by sympathetic tone loss

Describe Cauda Equina sydndrome

• Severe compression or inflammation of spinal nerves in lowest region of spinal canal

• Onset can be acute (hours/days) or chronic

• It is a surgical emergency - urgent decompression required

• Any of following are red flags

  • Numbness in groin/perineum/buttocks (Saddle anesthesia)

  • Bladder or bowel dysfunction

  • Sexual dysfunction

  • Lower limb weakness and/or sensory deficit (disturbed gait/inability to walk)

  • Reduced or absent lower limb reflexes

Describe signs and symptoms of Spinal Injury

• Pain anywhere along spine

• Loss of sensation in limbs

• Loss of movement in limbs

• Altered sensation in trunk or limbs (pins needles/burning/electric shock)

• Hypotension With bradycardia in C-spine injuries

• Diaphragmatic or abnormal breathing

• Hypotension with warm peripheries or vasodilation

• Flaccid muscles (no tone) with absent reflexes

• Priapism

Describe management of spinal injury

• Safety

• CABCDE

• Maintain c spine with cervical collar or MILS

• Extricate to safe place for assessment

• Assess and manage pain

• Asses patient using immobilisation algorithm

• Immobilise entire spin if indicated (collar, blocks and scoop)

• Rescue/spinal boards are for extrication only

• If immobilisation not possible, use padding/support

• Use major trauma triage tool to determine conveyance

• Pre-alert the receiving hospital if necessary

• Carry out secondary survey if time permits

• Convey smoothly

What are some potential complications when managing a patient with a spinal injury

• Airway problems - increased risk of aspiration

• Increased intracranial pressure

• Restricted respiration

• Dysphagia (problems with swallowing)

• Skin ulceration/pressure sores

• Pain

What are important documentation elements for spinal injuries?

• Was MILS used to maintain c-spine

• How extricated

• Use of immobilisation algorithm

• Was entire spine assessed?

• Was immobilised? What equipment?

• Which Major Trauma Tool triggered if any?