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Damage Control Orthopaedics
Published in Raymond Anakwe, Scott Middleton, Trauma Vivas for the FRCS (Tr & Orth), 2017
Raymond Anakwe , Scott Middleton
This patient is severely injured and will require the attention of a skilled trauma team. He should be treated along ATLS principles with attention to life-threatening injuries and while the system is sequential, the use of a team allows concurrent activity. Active haemorrhage should be controlled and blood products replaced. He should have intravenous access established and a chest drain sited for the pneumothorax. The limbs should be assessed for evidence of haemorrhage, extremity injury and vascular status. The open wound at the tibia should be inspected, gross contamination should be removed, a photograph taken and saline soaked gauze applied. Intravenous antibiotics, usually a cephalosporin, should be administered as well as tetanus toxoid. Spinal precautions should be maintained until the spine can be reliably clinically and radiographically cleared in order to prevent future disability. A trauma CT should be performed examining the head, cervical spine, chest, abdomen and pelvis. If there is any question over the vascular supply to the limbs then a CT angiogram can be performed additionally to identify any vascular injury to the lower limb. The limbs can be splinted temporarily in box splints or plaster to allow transfer.
Injuries of the spine
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Assessment and resuscitation according to a recognized protocol, such as the ATLS® protocol, precedes the assessment of the spinal injury. Adequate oxygenation and perfusion helps minimize secondary spinal cord injury. Spinal precautions need to be followed until the patient has been resuscitated and other life-threatening injuries have been managed. Immobilization continues until spinal injury has been excluded by both clinical and radiological assessment.
Effects of Spinal Immobilization and Spinal Motion Restriction on Head-Neck Kinematics during Ambulance Transport
Published in Prehospital Emergency Care, 2019
Florent Thézard, Neil McDonald, Dean Kriellaars, Gordon Giesbrecht, Erin Weldon, Rob T. Pryce
As with many other studies examining spinal precautions, the generalizability of results from healthy volunteers to patients in the field has limitations. Actual trauma patients are frequently anxious, injured, intoxicated, or uncooperative. Measures of participant comfort in this study showed both in-trial and end-of-trial comfort was significantly lower in SI than SMR: results that are expected and consistent with the properties of the long backboard and collar, but were not found in a similar study (11). Although subjective ratings by healthy volunteers are only an approximation of one component of overall patient presentation, it is likely that participant comfort is associated with H-N motion in various ways. The substantial amount of variation in the dependent variables that could not be attributed to vehicle motion/independent variables suggests other influences at work, such as: (1) voluntary motion related to comfort, anticipation, combativeness; (2) involuntary motions induced from prior vehicular motion (e.g., due to a temporal delay and/or additive contributions of successive accelerations); (3) limitations in the method of assessing vehicular motion; and (4) a non-linear nature of restraint provided by SI appliances. These possibilities deserve additional study, across all phases of prehospital care and in scenarios that are as clinically realistic as possible.
New Immobilization Guidelines Change EMS Critical Thinking in Older Adults With Spine Trauma
Published in Prehospital Emergency Care, 2018
Linda Underbrink, Alice “Twink” Dalton, Jan Leonard, Pamela W. Bourg, Abigail Blackmore, Holly Valverde, Thomas Candlin, Lisa M. Caputo, Christopher Duran, Sherrie Peckham, Jeff Beckman, Brandon Daruna, Krista Furie, Debra Hopgood
In the pre-implementation period of this study, fewer than 60% of the patients were transported using full immobilization. This rate appears low considering that the Foothills RETAC required all EMS agencies to transport patients with a suspected spinal injury fully immobilized. Ultimately, the type of spinal precautions used was at the discretion of the treating EMS personnel. Patients with medical conditions such as chronic obstructive pulmonary disease, asthma, pneumonia, or congestive heart failure may not be good candidates for full immobilization. Since our study population was ≥60 years, it is possible that some patients had these comorbidities. It is also possible that the EMS provider did not recognize the seriousness of the injury based on the reported symptoms or the mechanism of injury and did not use spinal precautions. Unfortunately, as described in the limitations, we did not have details on the patients’ pre-injury status or the ability to account for why patients received a specific immobilization type.