What are the two major functions of the nervous system?
Communication and control
- enables a individual to be aware of their enviroment (communication)
- coordinates the responses of the body to changes in the environment and keeps body systems working together (control)
What are the structural devisons of the nervous system?
Central nervous system (brain + spinal cord)
Peripheral nervous system (consists of nerves located outside of brain + spinal cord)
Within the PNS, we have the voluntary (skeletal muscle control) and automatic nervous system (influences involuntary muscles and glands + the ANS is partly independent)
Lastly, within the ANS, we have the parasympathetic (relax) and sympathetic (fight or flight) nervous system
What is the principle support system of the body?
The spinal column or vertebral column (same thing)
How many vertebrae makeup the spinal column? And what type of vertebrae are they?
33 irregular shaped vertebrae (bone)
Anatomy of a vertebrae?
The body (bulky part that faces forward)
Spinous process (back of vertebrae)
*vertebrae are held together by ligaments (makes sense, like to like)
What if found between vertebrae?
Disk (fluid-filled pad of tough elastic cartilage that acts as a shock absorber)
What are the five parts of the spinal column?
Cervical (C1-C7) (neck) (most mobile and delicate) (injury to Cervical is the most common cause of spinal cord injury)
Thoracic (T1-T12) (upper back)
Lumbar (L1-L5) (lower back)
Sacral/ Sacrum (next 5) (fused together) (posterior of pelvis)
Coccyx (next 4) (fused together)(tailbone)
What is the spinal cord surrounded by?
A sheath of protective membranes (meninges) and a cushioning layer of CSF
- the cord is composed of nervous tissue and exits the brain true opening at the base of the skull
- the cord gets narrower as it goes (cervical fills 95% of spinal canal but lumber only fills 60%)
- all nerves to the trunk and extremities originate from the spinal cord
- the spinal cord carries messages from the brain to various parts of the body through nerve bundles
What are the 3 main types of tracks tested in an assessment within the spinal cord
- motor tracts (carry impulses down the spinal to the muscles) (motor tracts on the right allow the patient to move their right side and vice versa)
- pain tracts (carry impulses from pain receptors up the spinal to the brain) (pain inflicted upon the patient’s right side is felt on their left pain tracts and vice versa)
- light touch tracts (carry light touch impulses from sensory receptors up the spinal to brain) (light touch is felt on the right side if applied to the right side and vice versa)
*because light touch and pain are carried by different tracks, the patient may be able to feel pain , but not light touch. This finding can be present if the spinal cord is partially but not completely injured.
What are the most common causes of spinal injuries in those less than 65 yrs old? (5)
- automobile/MVA (48%)
- falls (27%)
- GSW and penetrating injuries (15%)
- recreational and sports (14%)
- other (2%)
True or false , a patient can suffer from a spinal column injury and not suffer from a spinal cord injury
True. However , improper management of this patient can convert a spinal column injury into a spinal cord injury. They may be walking about and present no neutologic deficits. This could lead to permanent paralysis. Conversely , a patient can have spinal cord injury without any spinal column damage.
When a patient suffers a spinal cord injury, but not a spinal column injury injury.What is this called?
Spinal cord injury without radiologic abnormality (SCIWORA)
Give me the percentage of how common it is to suffer a spinal injury in each of the parts of the vetrebral column?
Cervical 55%
Thoracic 15%
Thoracolumbar 15%
Lumbosacral 15%
Where are fractures mre common in elderly patients, with rheumatoid arthritis and those with down syndrome
C1 and C2. Down syndrome patients because of abnormal development of the odontoid (C2 vetrebrae)
Pediatric patients spines are different than an adult spine up until what age?
8 yrs old. The pediatric spine has much more flexible ligaments and joint capsules.In addition the flat joints and vertebral bodies are more anterior and have a tendency to slide forward with a flexation of the vertebral column. From 8-12 yrs old , the differences in vertebral columns steadily change at 12 years of age , the pediatric spine is similar to the adult in structure.
What is the spine , particularly susceptible from what mechanisms of injury? (7)
- compression , this is when the weight of the body is driven against the head ( common in falls, diving accidents, MVA, or others in which a person impacts an object headfirst)
- flexion. When there is severe forward movement of the head in which the chin meets the chest or when the torso excessively curled forward
- extension. When there’s severe backward movement of the head , in which the neck is stretched or when the torso severely arched backwards.
- rotation. When there’s lateral movement of the head or spine beyond its normal limit
- lateral bending. When the body or neck is bent severely from the side.
- distraction. When the vertebrae and spinal cord are stretched and pulled apart. Common in hangings.
- penetration. When there’s injury from gunshots , stabbings or other types of penetrating trauma that involve the cranium or spinal column.
- suspect spinal injury in any case of these mechanisms , even if the patient seems fine. Injured vertebrae that are still aligned.But unstable can become unstable at any moment and damage or sever , the spinal cord. Do spine motion restriction. This is to keep the spine in anatomic alignment and to restrict its movement.
Why does neurogenic hypotension from spinal shock occur?
Also called spinal vascular shock results from an injury to the spinal cord.That interrupts nerve impulses to the arteries. When the arteries lose nerve impulses from the brain and spinal cord, they relax and dilate the vase with dilation causes a relative hypovolemia (too litte blood for so much space) within the circulatory system.\nThe patient becomes hypotensive.
S/S of neurogenic shock
- sympathetic nerve impulses to the adrenal glands are loss , which prevents the release of epinephrine and norepinephrine. This leads to vasodilation, which can present as red or flush skin
- lack of sweat glands , simulation causes skin to become dry
- the blood pooling in the periphery and the lack of circulating hormones (epinephrine + norepinephrine), the patient’s physical signs are different from those of classic hypovolemic shock. Instead of pale moist skin , the skin will be warm and dry and appear , flushed or red
- the sympathetic impulses are impaired and the patient’s pulse is , typically 60-80 beats per minute. This is different from the fast rate you would find in hypovolemia
- hypovolemic and neurogenic shock can occur together , but the classic findings of hypovolemic shock may be masked by the spinal cord injury
- treatment for spinal shock is SMR and to keep the patient warm.Because of the increased heat loss from the peripheral vasodilation
S/S of possible spine injury (7)
- unprovoked pain in an area of injury, along spine, in lower legs
- tenderness , in which gentle touch of area may increase pain
- deformity , such as abnormal bend or bony , prominence (rare)
- soft tissue injury to the head , neck, or face (cervical injury) shoulders, back and abdomen (thoracic or lumbar injury) or extremities (lumbar or sacral spine injury)
- paralysis inability to move or feel sensation in some part of the body may indicate spinal fracture with cord injury
- painful movement (never try to move injured area as this can increase pain)
- lost a bowel or bladder control, priapism , prison or impaired breathing
Emergency medical care for spinal emergies? 9 steps
- Ppe and control bleeding
- Have patient self restrict or provide manual restriction ( if the patient complains of severe pain to the neck or cervical spine or the head does not easily move, maintain the head in position found)
- Open and maintain the airway (jaw thrust) insert OPA/NPA and suction, or provide ppv if necessary for spo2 > 94%
- Assess PMS
- apply C-collar (palate neck beforehand)
- Apply the correct C-collaer. An Improperly , size collar can cause more harm by compromising the airway and further aggregate a potential spinal injury. If the cervical collar does not fit properly use a rolled towel or blanket?Instead , loosely wrap the towel or blanket around the patient’s neck to take the place of the c-collar , taping the towel or blanket to the backboard.
- Secure patient stretcher, backboard, vacuum mattress, or scoop stretcher
- Reassess PMS
- transport
When considering SMR for a patient using a vest-type device, what should you keep in mind?
Current research has found that less manipulation of the spine is done when the patient moves himself out of the vehicle.In addition , this procedure is time consuming and should never be done on a patient with any physiologic instability , evidence of hypovolemic or shock or any head, chest , abdominal, pelvic femur , or multiple fractures.
- if the patient with a suspected spinal injury is in a seated position , a short spine motion restriction device might be used
What are the general steps to use a vest type device? (8)
- Manual stabilization and apply C-collar (do PMS)
- Position the short spinal device behind the patient. Examine the back. Slide the board behind the patient.As far into the seat as you can , the top of the board should be level with the top of the patient’s head and the bottom of the board should not exceed the coccyx. The body flap should fit snugly under the patient’s armpits.
- Secure the device to the patient’s torso. Make sure the straps are tight enough.\nApply leg straps if the device has them.
- Pad behind the patient’s head to ensure neutral alignment of the head and neck. Do not apply excessive padding as this causes the head and neck to flex forward and do not apply lack of padding as this allows the head and neck to be extended.
- Secure the patient’s head to the device
- Position a long backboard under or next to patients , buttocks and rotate him until his back is in line with the backboard. Tie the hands together in pivot , the patient onto the backboard. If it is not possible to get the backboard next to the patient , lift the patient under his arms and legs and lower him onto the backboard.
- Follow the guidelines for securing a patient to a long backboard. Assess PMS
- PROCEED WITH CARE AS DESCRIBED EARLIER
What are some considerations?You should consider when using a short spinal device? (9)
- perform any assessment of the back, scapula , arms or clavicles before you apply the board
- angle the board to fit between the arms of the rescuer who is stabilizing the patient’s head
- push the spine board as far down into seat as possible if you don’t , the board might shift and the patients , C- spine might compress. Top of the board must be level with the top of the patient’s head , and the base must not extend past the coccyx.
- never place a chin cup or chin strap on the patient.They prevent the patient from vomiting
- when applying the first straps to the torso , take care not to apply too tightly , which could cause abdominal injury or impair breathing
- always tighten the torso and leg straps before securing the patient’s head.This prevents accidental movement of the patient’s cervical spine.
- never allow buckles to be placed midsternum where they could interfere with CPR
- never pad between a C - collar and the board.Doing so creates a pivot point that might cause hyper extension of the cervical spine
- ASSESS PMS BEFORE AND AFTER APPLICATION OF DEVICE
