United States Department of Transportation

National Highway Traffic Safety Administration

Paramedic: National Standard Curriculum

(Reprinted with permission)

http://www.nhtsa.dot.gov/people/injury/ems/

Trauma: 4

Spinal Trauma: 6s

UNIT TERMINAL OBJECTIVE

4-6 At the completion of this unit, the paramedic student will be able to integrate pathophysiological principles and the assessment findings to formulate a field impression and implement a treatment plan for the patient with a suspected spinal injury.

COGNITIVE OBJECTIVES

At the completion of this unit, the paramedic student will be able to:

4-6.1 Describe the incidence, morbidity, and mortality of spinal injuries in the trauma patient. (C-1)

4-6.2 Describe the anatomy and physiology of structures related to spinal injuries. (C-1)

a. Cervical

b. Thoracic

c. Lumbar

d. Sacrum

e. Coccyx

f. Head

g. Brain

h. Spinal cord

i. Nerve tract(s)

j. Dermatomes

4-6.3 Predict spinal injuries based on mechanism of injury. (C-2)

4-6.4 Describe the pathophysiology of spinal injuries. (C-1)

4-6.5 Explain traumatic and non-traumatic spinal injuries. (C-1)

4-6.6 Describe the assessment findings associated with spinal injuries. (C-1)

4-6.7 Describe the management of spinal injuries. (C-1)

4-6.8 Identify the need for rapid intervention and transport of the patient with spinal injuries. (C-1)

4-6.9 Integrate the pathophysiological principles to the assessment of a patient with a spinal injury. (C-3)

4-6.10 Differentiate between spinal injuries based on the assessment and history. (C-3)

4-6.11 Formulate a field impression based on the assessment findings. (C-3)

4-6.12 Develop a patient management plan based on the field impression. (C-3)

4-6.13 Describe the pathophysiology of traumatic spinal injury related to: (C-1)

a. Spinal shock

b. Spinal neurogenic shock

c. Quadriplegia/ paraplegia

d. Incomplete cord injury/ cord syndromes:

1. Central cord syndrome

1. Anterior cord syndrome

2. Brown-Sequard syndrome

4-6.14 Describe the assessment findings associated with traumatic spinal injuries. (C-1)

4-6.15 Describe the management of traumatic spinal injuries. (C-1)

4-6.16 Integrate pathophysiological principles to the assessment of a patient with a traumatic spinal injury. (C-3)

4-6.17 Differentiate between traumatic and non-traumatic spinal injuries based on the assessment and history. (C-3)

4-6.18 Formulate a field impression for traumatic spinal injury based on the assessment findings. (C-3)

4-6.19 Develop a patient management plan for traumatic spinal injury based on the field impression. (C-3)

4-6.20 Describe the pathophysiology of non-traumatic spinal injury, including: (C-1)

a. Low back pain

b. Herniated intervertebral disk

c. Spinal cord tumors

4-6.21 Describe the assessment findings associated with non-traumatic spinal injuries. (C-1)

4-6.22 Describe the management of non-traumatic spinal injuries. (C-1)

4-6.23 Integrate pathophysiological principles to the assessment of a patient with non-traumatic spinal injury. (C-3)

4-6.24 Differentiate between traumatic and non-traumatic spinal injuries based on the assessment and history. (C-3)

4-6.25 Formulate a field impression for non-traumatic spinal injury based on the assessment findings. (C-3)

4-6.26 Develop a patient management plan for non-traumatic spinal injury based on the field impression. (C-3)

AFFECTIVE OBJECTIVES

At the completion of this unit, the paramedic student will be able to:

4-6.27 Advocate the use of a thorough assessment when determining the proper management modality for spine injuries. (A-3)

4-6.28 Value the implications of failing to properly immobilize a spine injured patient. (A-2)

PSYCHOMOTOR OBJECTIVES

At the completion of this unit, the paramedic student will be able to:

4-6.29 Demonstrate a clinical assessment to determine the proper management modality for a patient with a suspected traumatic spinal injury. (P-1)

4-6.30 Demonstrate a clinical assessment to determine the proper management modality for a patient with a suspected non-traumatic spinal injury. (P-1)

4-6.31 Demonstrate immobilization of the urgent and non-urgent patient with assessment findings of spinal injury from the following presentations: (P-1)

1. Supine

2. Prone

3. Semi-prone

4. Sitting

5. Standing

4-6.32 Demonstrate documentation of suspected spinal cord injury to include: (P-1)

a. General area of spinal cord involved

b Sensation

6. Dermatomes

7. Motor function

8. Area(s) of weakness

4-6.33 Demonstrate preferred methods for stabilization of a helmet from a potentially spine injured patient. (P-1)

4-6.34 Demonstrate helmet removal techniques. (P-1)

4-6.35 Demonstrate alternative methods for stabilization of a helmet from a potentially spine injured patient. (P-1)

4-6.36 Demonstrate documentation of assessment before spinal immobilization. (P-1)

4-6.37 Demonstrate documentation of assessment during spinal immobilization. (P-1)

4-6.38 Demonstrate documentation of assessment after spinal immobilization. (P-1)

DECLARATIVE

I Introduction

A0 Spinal cord injury (SCI) impacts

1 Human physiology

2 Lifestyle

3 Financial

4 1.25 million to care for a single victim with permanent SCI (overall life span)

II Incidences

A0 15,000 - 20,000 SCI per year

B0 Higher in men between ages 16 - 30 years

C0 Common causes

1 Motor vehicle crashes - 2.1 million per year (48%)

2 Falls (21%)

3 Penetrating injuries (15%)

4 Sports injuries (14%)

III Morbidity and mortality

A0 40% of trauma patients with neurological deficit will have temporary or permanent SCI

B0 25% of SCI may be caused by improper handling

C0 Education in proper handling and transportation can decrease SCI

IV Traditional spinal assessments/ criteria

A0 Based upon mechanism of injury (MOI)

B0 Past emphasis for spinal immobilization considerations

1 Unconscious accident victims

2 Conscious accident victims checked for SCI prior to movement

3 Any patient with a “motion” injury

C0 Lack of clear clinical guidelines or specific criteria to evaluate for SCI

D0 Signs which may indicate SCI

1 Pain

2 Tenderness

3 Painful movement

4 Deformity

5 Cuts/ bruises (over spinal area)

6 Paralysis

7 Paresthesias

8 Paresis (weakness)

9 Shock

10 Priapism

E0 Not always practical to immobilize every “motion” injury

F0 Most suspected injuries were moved to a normal anatomical position

1 Lying flat on a spine board

2 No exclusion criteria used for moving patients to an anatomical position

G0 Need to have clear criteria to assess for the presence of SCI

V General spinal anatomy and physiology review

A0 Spinal column

1 Long bone

2 33 vertebrae

3 Head balances at top of spine

4 Spine supported by pelvis

5 Ligaments and muscles connect head to pelvis

a0 Anterior longitudinal ligament

(1) Runs on anterior portion of the body

(2) Major source of stability

(3) Protects against hyperextension

b0 Posterior longitudinal ligament

(1) Runs along posterior body within the vertebral canal

(2) Prevents hyperflexion

(3) Can be a major source of injury

c0 Other ligaments

(1) Cruciform ligament

(2) Accessory atlantoaxial ligament

(3) Add to strength, stability, and articulation

6 Injury to ligaments may cause excess movement of vertebrae

B0 Cervical spine

1 7 vertebrae

2 Supports head (16 - 25 lbs)

3 Considered “joint above” in splinting

4 Very flexible

5 C1 (atlas)

6 C2 (axis)

C0 Thoracic spine

1 12 vertebrae

2 Ribs connected

3 Provides rigid framework of thorax

D0 Lumbar spine

1 5 vertebrae

2 Largest vertebral body

3 Flexible

4 Carries most of body weight

5 Torso balances on sacrum

E0 Sacrum

1 5 fused vertebrae

2 Common to spine and pelvis

3 Forms “joint below” with pelvis for splinting

F0 Coccyx

1 4 fused vertebrae

2 Tailbone

G0 Vertebral structure

1 Body

a0 Constructed of cancellous bone