L3 Spinal Pelvic Injuries v1 October 2020 PDF

Support the management of trauma in the emergency and urgent care setting Component 8 Spinal & Pelvic Injuries  Pelvic Injuries - Component 8 Objective Identify the mechanism of injury, the signs and symptoms and describe the management of...

Support the management of trauma in the emergency and urgent care setting Component 8 Spinal & Pelvic Injuries  Pelvic Injuries - Component 8 Objective Identify the mechanism of injury, the signs and symptoms and describe the management of pelvic and spinal injuries.  Pelvic Injuries - Component 8 Pelvic Injuries Pelvic fractures represent 3-6% of all fractures in adults Occur in 20% of all polytrauma cases 75% of all pelvic injuries occur in men Haemorrhage is the cause of death in 40% pelvic trauma patients © Department of Clinical Education & 3 Standards  Pelvic Injuries - Component 8 The Pelvis Anterior view Posterior view © Department of Clinical Education & 4 Standards  Pelvic Injuries - Component 8 Causes of Pelvic Injuries High energy transfer e.g. RTC Fall from height Crush injury Can also be from simple falls with risk factors: Elderly Degenerative bone diseases Receiving radiotherapy © Department of Clinical Education & 5 Standards Pelvic Injuries - Component 8 Pelvic Injuries - RTC Any significant door intrusion into the passenger space should give cause for concern, as should a dented petrol tank on a motor bike. ©Department of Clinical Education & Standards  Pelvic Injuries - Component 8 Pelvic Injuries - Falls from Height Remember Distracting injuries can occur e.g. fractured ankle ©Department of Clinical Education & Standards Pelvic Injuries - Component 8  Pelvic Injuries - Component 8 Complications Increased pelvic volume due to fracture allows for increased haemorrhage Vascular injuries leading to haemorrhage Urogenital injuries – bladder rupture in 10% Common to have other injuries to manage e.g. intra- thoracic/intra-abdominal ©Department of Clinical Education & Standards  Pelvic Injuries - Component 8 Signs & Symptoms Mechanism Bruising Bleeding from the patient’s rectum, vagina or urethra Deformity Swelling Shortening of lower limb Pain over the hips, groin or lower back Hypovolemic shock Altered sensation in one leg ©Department of Clinical Education & Standards  Pelvic Injuries - Component 8 Management of Pelvic Injuries What does the JRCALC Guideline say? ©Department of Clinical Education & Standards  Pelvic Injuries - Component 8 Management Time critical – DRABC & Splint Consider C-spine when managing airway Control catastrophic haemorrhage High flow O2 Pelvic Splint – immobilise knees and ankles as well Consider Paramedic assistance Pain relief Smooth rapid removal to MTC Full observations ©Department of Clinical Education & Standards  Pelvic Injuries - Component 8 Management Avoid repeated examinations/movements Never ‘spring’ the pelvis – this may dislodge blood clots may exacerbate injury Once the pelvic splint has been placed – do not remove ©Department of Clinical Education & Standards Pelvic Injuries - Component 8 ©Department of Clinical Education & Standards  Pelvic Injuries - Component 8 Pelvic Splint As the pelvic splint is cut to size, it can fit a massive range of patients from paediatric to bariatrics It is a single use device ©Department of Clinical Education & Standards  Pelvic Injuries - Component 8 Summary Pelvic injuries can lead to fatal haemorrhage Minimise movement when treating pelvic injuries and limit log roll to 10 degrees Pelvic injuries require immediate splinting and transport to MTC Pelvic splints are single-use only and once applied, will not be removed by ambulance clinicians. ©Department of Clinical Education & Standards Pelvic Injuries - Component 8 Any Questions? ©Department of Clinical Education & Standards Spinal Injuries - Component 8 Spinal Injuries ©Department of Clinical Education & Standards 26  Spinal Injuries - Component 8 Mechanisms of Injury Hyperflexion Hyperextension Rotation Compression One or more of these ©Department of Clinical Education & Standards 27  Spinal Injuries - Component 8 How Does Spinal Injury occur? 46% from Falls A third of these are less than 2 metres Increased risk in older people/Rheumatoid Arthritis 40% from Road Traffic Collisions – what increases the risk factors? 3% from Sporting injuries ©Department of Clinical Education & Standards 28  Spinal Injuries - Component 8 Types of Spinal Injuries Dislocation of vertebrae Fracture of vertebrae Displacement of vertebrae (prolapse) All of the above can lead to compression and/or stretching of the spinal cord leading to Spinal Cord Injury (SCI) ©Department of Clinical Education & Standards 29  Spinal Injuries - Component 8 ©Department of Clinical Education & 30 Standards Spinal Injuries - Component 8 31 ©Department of Clinical Education & Standards  Spinal Injuries - Component 8 Healthy Disc Bulging Disc Annular Fibre Herniated Disc Nucleus Pulposus Nerve Spinal Root Cord Facet ©Department of Clinical Education & Standards 32  Spinal Injuries - Component 8 Other causes of Spinal Injuries Spinal Tumours Vascular thrombosis or haemorrhage Infection Abscesses caused by TB or meningitis ©Department of Clinical Education & Standards 33  Spinal Injuries - Component 8 Complications of Spinal Injuries Damage to spinal cord Compression of spinal cord Spinal shock Neurogenic shock Respiratory difficulties Cauda Equina Syndrome ©Department of Clinical Education & Standards 34  Spinal Injuries - Component 8 Spinal Shock After Spinal Cord Injury (SCI): State of complete loss of motor function Can have possible loss of sensory function Can go on for considerable time Recovery may occur ©Department of Clinical Education & Standards 35  Spinal Injuries - Component 8 Neurogenic Shock After Spinal Cord Injury (SCI): Poor tissue perfusion Caused by sympathetic tone loss ©Department of Clinical Education & Standards 36  Spinal Injuries - Component 8 Respiratory Difficulties After Spinal Cord Injury (SCI): Damage to upper cervical cord Paralysis of diaphragm and respiratory muscles ©Department of Clinical Education & Standards 37  Spinal Injuries - Component 8 Cauda Equina Syndrome 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 ©Department of Clinical Education & Standards 38 Spinal Injuries - Component 8 Cauda Equina Syndrome Clinical Red Flags: Any of the following are significant in the presence of lower back pain (generally sharp or stabbing) and/or unilateral or bilateral lower limb pain, radiating from the lower back (sciatic type pain): Numbness in the 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 ©Department of Clinical Education & Standards 39 ©Department of Clinical Education & 40 Standards  Spinal Injuries - Component 8 Signs & Symptoms of Spinal Injury Common Signs/Symptoms of fracture and/or: Pain anywhere along the spine (neck or back) Loss of sensation in the limbs Loss of movement in the limbs Altered sensation in the trunk or limbs (of pins and needles/ burning/ electric shock) ©Department of Clinical Education & Standards 41  Spinal Injuries - Component 8 Signs & Symptoms of Spinal Injury Associated symptoms may indicate level of injury: Hypotension