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Spinal Injuries Notes

Abdominal Aortic Aneurysm (AAA)

  • An aneurysm in the abdominal area of the aorta. During surgery to remove the aneurysm, surgeons discovered that removing the section of the aorta with collateral circulation to the spinal cord can lead to loss of blood supply to the spinal cord.
  • This can result in numbness, paralysis, tingling, loss of bladder or bowel control about a month after surgery.
  • Modern surgical approaches now anticipate and preserve perfusion of the spinal cord during AAA surgeries.

Spinal Motion Restriction (SMR) and Neutral Alignment

  • Spinal Motion Restriction (SMR): Immobilizing the head and spinal cord.
  • Neutral Alignment: Ensuring there's no flexion or extension of the neck.
  • General Treatment Principles: Apply SMR to maintain neutral alignment, minimize heat loss, and maintain oxygenation.

Paramedic Prompt Card for Spinal Motion Restriction

  • A flowchart tool based on a multi-year study at the University of Ottawa, Ottawa General Hospital, and Ottawa Base Hospital to determine whether to immobilize a patient's spine.
  • The study involved analyzing ambulance patients with spinal precautions for a year to determine the occurrence of actual cord injuries.
  • A protocol was developed and tested to determine if it would have indicated immobilization, followed by field application to assess cord injuries upon arrival at the emergency department.
  • The goal is to clinically determine whether to immobilize the patient’s spine, considering the mechanism of injury and signs and symptoms

Applying the Flowchart

  1. Mechanism of Injury: Assess if there's a mechanism of injury suggestive of potential spine injury (e.g., diving injuries, falls, penetrating trauma, high-velocity car accidents).
  2. Risk Criteria:
    • Risk criteria identified in the study include:
      • Neck/back pain, tenderness.
      • Numbness, tingling, or paralysis.
      • Altered level of consciousness.
      • Deformity of the spine.
      • High-energy mechanism of injury.
      • Patients 65+ with a fall.
    • If none of these risk criteria are present, SMR is not required.

Decision Points

  • If a patient has a mechanism of injury and any risk criteria, further assessment is needed.
  • Ask: Is there penetrating trauma in the mechanism, or are there any modifiers present (spine tenderness, numbness, tingling, paralysis)?
  • If no modifiers are present, SMR is still not required.
  • If spine tenderness, numbness, tingling, or paralysis are present, then apply SMR.

Double Negatives in BLS Standards

  • The BLS standards' format uses double negatives, which can be confusing (e.g., "If the patient has penetrating trauma with all penetrating modifiers present, no spinal motion restriction required").
  • An alternative flowchart was created to avoid double negatives, aiming for the same endpoints but with clearer logic.

Impact of the Restriction Standard

  • The spinal motion restriction standard has led to a reduction in spinal immobilization in the field.
  • For patients with suspected spinal cord injuries, C-collar, backboard, KED, or scoop stretcher are still used.
  • The approach is now more targeted (