Clinical paramedicine 2 HSC6115D
Pre-hospital Spinal Immobilization
Word count = 2703
Spinal cord injury
Cervical spine immobilization
Full spinal immobilization
Background: A literature review form a variety of references, in particular journal articles, textbooks and information from appropriate academic websites. These resources have been analysed and a conclusion drawn from them in regards to spinal immobilisation in the pre-hospital setting.
Method: This assignment uses an evidence based approach; the author explores spinal injuries and the current management of them in the pre-hospital setting across a number of countries. The author relates current practice with recent literature and draws a final conclusion from the findings.
Conclusion: Prehospital care for patients with acute traumatic spinal injuries requires great care to avoid secondary injury; recognition of potential injury is of great importance. Although injuries to the spinal cord occur in 2% of the patients that paramedics immobilize, pre-hospital management and treatment can play a significant role in the patient’s outcome. There is growing evidence that full body immobilization can be of more harm than good if not done correctly.
Traumatic spinal cord injuries are severe, life threatening and life altering. Managing the risk of spinal cord injury in trauma patients is an understandable concern for medical professionals. Spinal immobilization is initiated on a regular basis in pre-hospital setting for patients at risk of a spinal cord injury. In the past immobilization has been thought to be a relatively harmless procedure. There is now, however, growing evidence that this approach can be harmful, pre-hospital spinal immobilization in trauma patients should be questioned and explored. There is a large amount of literature on pre-hospital immobilization; the purpose of this paper is to review the current literature and make a recommendation for New Zealand practice. This paper explores current pre-hospital management of spinal cord injuries, the literature around cervical spine immobilization and full body immobilization.
Spinal cord injury
Spinal cord injury is injury to the spine with any localised damage to the spinal cord or to the roots that lead to some functional loss, either loss of motor function (paralysis) or sensory loss (paresthesias). Spinal cord injuries are caused by the spine being forced beyond its normal range, injury can be caused by hyperflexion, hyperextension, rotation, compression, or penetrating injury of the spinal cord. The leading causes of injury to the spinal cord includes car accidents (40%), falls (21%), acts of violence (15%), sporting injury (13%) (Sanders, 2012)
Spinal injuries may be classified into sprains, strains, fractures, dislocations and/or actual cord injuries. Spinal cord injuries are further classified as complete or incomplete and may be the result of pressure, contusion or laceration of the spinal cord (Marieb & Hoehn, 2010).
It is very important for paramedics and emergency personal to know that pain from a spinal cord injury is not necessarily localized to the area of the injury. In 18% of cervical, 63% of thoracic and 9% of lumbar injuries, the pain is located elsewhere (Bernhard, Gries, Kremer, & Bottiger, 2005).
Pre-hospital management of acute spinal cord injury is of critical importance, it has been estimated that 25% of spinal cord damage may occur or be aggravated after the initial event (Bernhard, Gries, Kremer, & Bottiger, 2005). Pre-hospital treatment of patients with a spinal cord injury involves recognition of patients at risk and appropriate immobilisation (Tintinalli, 2011). Spinal immobilization and spinal...
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