C-Spine Injury C.A Presetation

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I.  Introduction The spine is made up of 33 vertebrae superimposed one on top of the other. The spine begins at the base of the skull and extends to the basin. Its role is to protect the spinal cord cord that is inside, and support the head and trunk. The 33 vertebrae are actually five five spinal segments, or if  you prefer five smaller spines superimposed on each other. The first of these is the cervical spine, consisting of 7 cervical vertebrae in the neck. As you can see, this is a critical system for  our human body. The spine bones of the neck, the cervical vertebrae, may be fractured or  displaced if the neck is twisted, compressed, or hyper-extended. A fracture (break) or  displacement of the cervical spine (C-spine) can cut c ut or press on the spinal cord. Regardless of the cause, cervical spine fractures are serious injuries; they may involve spinal cord damage that can result in partial or complete paralysis or even death. We the BSN IV- B Group 6 students of Saint Gabriel College were assigned to make a scenario demonstrating an emergency intervention to a patient having cervical spine injury for  the subject Competency Appraisal 2. At the course of the conduct of the presentation, we  personally found out that attending to such emergency needs to be systematic because of its complexity. Though it appears to be simple when discussed in the classroom but in an actual situation, it requires a skilled and knowledgeable person who is well trained in attending to such emergency. As nursing students, this presentation has helped us a lot to the application app lication of what we’ve discussed in the classroom regarding emergencies. This also made us all more confident that if faced with such scenario we could co uld somehow give a hand for help. First aid is important in emergency situations and when one knows k nows how to respond appropriately du during ring these times a life could be saved.

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II.  OBJECTIVES General Objective: At the end of the presentation, we the BSN IV- B Group 6 assigned to discuss Cervical Spine Injury will be able to utilize knowledge, develop skills and form the right attitude regarding the Emergency Principles and interventions in terventions on responding to a patient with Cervical Spine Injury. Specific Objectives: Specifically the group aims to accomplish the following: Knowledge:                            

Define Cervical Spine Injury. Discuss the Anatomy and Physiology of the Cervical Spine. Identify the cause of the injury. Discuss the Pathophysiology of the condition. Enumerate the signs and symptoms of C-Spine Injury. Identify the priority in attending an emergency situation thru triaging/triage system. Enumerate the specific Diagnostic Tests for Cervical Spine Injury. Discuss the Medical Management for Cervical Spine Injury. Explain the Surgical Management of the said condition. Enumerate and discuss the Emergency Action Principle for every intervention. Discuss profoundly by utilizing the 11 key areas of responsibility. Distinguish the possible legal aspects in attending an emergency situation for a client with cervical spine injury. Be guided by the objectives of the emergency management. Enumerate the possible complication of the condition.

Skills:      

   

Demonstrate the accurate emergency action procedure in attending a client with cervical spine injury. Enhance our skills in giving emergency care for a client having cervical spine injury. Proper channelling of communication from the person involved in the treatment or from the authority. Enhance our communication skills. Enhance skills in utilizing medias like videos in presenting the presentation.

Attitude:  

Develop self confidence in performing interventions during emergency situations.   To establish teamwork among group members.  

Develop calmness and avoid panic when attending such emergency situation.

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III. 

DISCUSSION

i. 

ANATOMY AND PHYSIOLOGY

Cervical Vertebrae and Supporting Spinal Structures

The cervical bones (the vertebrae) are smaller in size when compared to other  spinal vertebrae (in your thoracic or lumbar spines). The purpose of the cervical spine is to contain and protect the spinal cord, support the skull, and enable diverse head movement (e.g., rotate side to side, bend forward and backward). A complex system of ligaments, tendons, and muscles mu scles help to support and stabilize the cervical spine. Ligaments work to prevent excessive movement move ment that could result in serious injury. Muscles also help to provide spinal balance and stability, and enable movement. Muscles contract and relax in response to nerve ne rve impulses originating in the brain. Some muscles work in pairs or as antagonists. This means when a muscle contracts, the opposing muscle relaxes. There are different types of muscle: forward flexors, lateral flexors, rotators, and extensors.

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Spinal Cord and Cervical Nerve Roots

 Nerve impulses travel to and from the brain through the spinal cord to a specific location  by way of the peripheral nervous system (PNS). The PNS is the complex system of  nerves that branch off from the spinal nerve roots. These nerves travel outside of the spinal canal or spinal cord into the organs, arms, legs, fingers — throughout throughout the entire  body.  Injury or mild trauma to the cervical spine can cause a serious or life-threatening medical emergency (eg, spinal cord injury or a spinal fracture). Pain, numbness, weakn weakness, ess, and tingling are symptoms that may develop when one or more cervical spinal nerves aare re injured, irritated, or stretched. Because the cervical nerves control many bodily bodil y functions and sensory activities, specific symptoms from a cervical spine injury vary depending on which nerves are affected. Below, the parts of the body controlled by b y cervical nerves are summarized. 

   



 



 



 



 



 



C1: Head and neck  C2: Head and neck  C3: Diaphragm C4: Upper body muscles (eg, deltoids, biceps) C5: Wrist extensors C6: Wrist extensors C7: Triceps

ii.  CAUSE  

Motor vehicle accident   Falls   Sports injuries   Violence or Assault

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iii.  PATHOPHYSIOLOGY Acceleration- deceleration

Hyperflexion

Torn posterior longitudinal ligament

Hyperextension

Compression of cord by ligamentum flavium & disc

Distortion of cord

Torn anterior longitudinal ligament

Anterior dislocation

Microscopic bleeding

Edema

Inhibition of the SNS

Vasoconstriction

Bradycardia

Stroke/ Heart Failure

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iv.  SIGNS AND SYMPTOMS Cervical (neck) injuries usually result in full or partial tetraplegia (Quadriplegia). (Quadriplegia). However, depending on the specific location and severity of trauma, limited function may be retained. 

  Injuries at the C-1/C-2 levels will often result in loss of breathing, necessitating mechanical ventilators or  or phrenic phrenic nerve pacing.  pacing.    C3 vertebrae and above : Typically results in loss of diaphragm of diaphragm function, necessitating the use of a ventilator for breathing.   C4 : Results in significant loss of function at the biceps and shoulders.   C5 : Results in potential loss of function at the shoulders and biceps, and complete loss of function at the wrists and hands.   C6 : Results in limited wrist control, and complete loss of hand function.   C7 and T1 : Results R esults in lack of dexterity in the hands aand nd fingers, but allows for limited use of arms.







 

Patients with complete injuries above C7 typically cannot handle activities of daily living and   cannot function independently. Additional signs and an d symptoms of cervical injuries include: 

  Inability or reduced ability to regulate heart rate, blood    pressure, sweating and hence body temperature.   Autonomic dysreflexia or abnormal increases in blood pressure, sweating, and other autonomic responses to pain or sensory   disturbances.



For a Severe Injury Subjective Pain is felt in the back, neck, and/or head. The  pain can be severe  Stiff neck  

Objective The scalp, neck, or back bleeds

It looks like the head, neck, or back is in an odd position  Vomiting  Blood or fluid comes from the mouth, nose, or  an ear   Pupils are not the same size   Inability to move any part of the body  Walking is difficult 

Abdominal pain  Loss of vision  Blurred or double vision  Weakness in an arm or leg    New feelings of numbness occur in the legs, arms, shoulders, or any other part of the body bod y   New loss of bladder or bowel control occurs  Confusion

Personality changes  Convulsions 

Drowsiness 

Loss of consciousness 

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For a Whiplash Injury 

Subjective  Neck pain and stiffness

Objective Having a hard time raising the head off of a  pillow

v.  EPIDEMIOLOGY   Frequency



Cervical spine injuries cause an estimated 6000 deaths and 5000 new cases of  quadriplegia in the US each year.

  Sex



Male-to-female ratio is 4:1.

  Age



Most patients with a cervical spine injury are in their prime and leading an active lifestyle  prior to injury. Approximately 80% of patients are aged 18-25 years.

  Race



There is also a known trend that exists in the racial distribution of victims. For example, since year 2005, 66.1% of those who suffered from spinal cord injuries are Caucasian and 27.1% are African Americans along with 0.9% Asians.

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vi.  DIAGNOST DIAGNOSTIC IC TESTS 

  Cervical spine X-rays: X-rays:  

A standard series of X-rays of the cervical spine consists of three views: anteroposterior, lateral and anteroposterior odontoid peg views. The lateral view must show the top of the T1 vertebral body, and the odontoid peg view should show the lateral masses of the atlanto-axial articulation. In children aged <10, use anterior/posterior and lateral radiographs without an anterior/posterior peg view, and use CT imaging to clarify abnormalities or uncertainties. The following patients should have plain radiography (three views) vie ws) of the cervical spine: a.  Patients with neck pain or midline tenderness if aged ≥65 years, or any age if there was a dangerous mechanism of injury (see above).  b.  Patients where a definitive diagnosis of cervical spine injury is needed urgently (eg before surgery).

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c.  Any patients where it is considered unsafe to assess movement. Safe assessment can be carried out if the patient: i.  Was involved in a simple rear end motor vehicle collision. ii.  Is comfortable in a sitting position in the emergency department. iii.  Has been ambulatory at any time since injury injur y with no midline cervical spine tenderness. iv.  Has delayed onset of neck pain. d.  Patients initially considered safe to assess movement in the neck still need cervical spine X-rays if on assessment they cannot actively rotate the neck  45° to the left and right. NURSING REPONSIBILITIES Pretest: Tell the patient to:   To remove all clothing and jewelry from the waist up and change into a hospital gown  because buttons, zippers, clasps, or jewelry might interfere with with the image.  

If the patient has a suspected neck injury, a collar collar or brace will be placed around the neck to limit movement to the neck which helps prevent further injury to the neck.

 

If the patient is pregnant, it's important to tell the X-ray technician techn ician or her doctor. X-rays are typically avoided during pregnancy because there's a small chance the radiation may harm the developing baby. But if the X-ray is necessary, precautions can be taken to  protect the fetus. Intratest: Tell the patient that:   Although the procedure may take up to 15 minutes, actual exposure to radiation is usually only a few seconds.  

You will enter a special room that will contain a table and a large X-ray machine hanging from the ceiling or wall.

 

Parents are usually able to accompany accompan y their child to provide reassurance.

 

Cervical spine X-rays are performed while in a lying l ying position.

 

The technician will position your, then step behind a wall or to an adjoining room to operate the machine.

 

Three X-rays are usually taken so the technician will return to reposition you for each. Occasionally, additional X-rays are needed.

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 

Older kids will be asked to hold their breath and remain still for 2-3 seconds while each X-ray is taken; infants may require gentle restraint

 

. Keeping the neck still is important to prevent blurring of the X-ray image.

 

You won't feel anything as the X-rays X-ra ys are taken. The X-ray room ma may y feel cool due to air  conditioning used to maintain the equipment.

 

Positions required for the X-rays may feel uncomfortable, but they the y need to be held for  only a few seconds. Babies often cry cr y in the X-ray room, especially if the they're y're restrained,  but this won't interfere with the procedure.

 

If you stay in the room while the X-rays are being done, you'll be asked to wear a lead apron to protect certain parts of your body. bod y. Your child's reproductive organs also will be  protected with a lead shield.

 

After the X-rays are taken, you and your child will be asked to wait a few minutes while the images are processed. If any are blurred or unclear, the X-rays may need to be redone.

Post test:   After the test, the patient should be returned to their normal activities if these have been disturbed, i.e. eating and drinking, as quickly quickl y as possible.  

While most contrast medium allergies are instantaneous, nurses should be aware of   possible longer-term reactions over the next few hours or days, days, and observe patients accordingly.

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  CT scanning of cervical spine:

CT scan is indicated immediately if: i.  Patient had a Glasgow coma scale (GCS) <13 on initial assessment. ii.  Patient has been intubated, or is being scanned for multi-region trauma. CT is also indicated: iii.  If plain films are deemed inadequate, suspicious, or definitely abnormal. iv.  If clinical suspicion of injury continues despite a normal radiograph. Computed tomography is superior to plain radiography, with a reported sensitivity of 100% and specificity of 99%. NURSING REPONSIBILITIES Pretest Tell the patient that:  

Certain exams require a special dye, called contrast, to be delivered into the body  before the test starts. Contrast helps certain areas show up better on the x-rays.

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Contrast can be given in different ways:

  It may be delivered through a vein v ein (IV) in your hand or forearm.   It may be given as an injection into the space surrounding the spinal cord.   If contrast is used, you may also be asked ask ed not to eat or d drink rink anything for 4-6 hours before the test. 



 

Let your doctor know if you have ever had a reaction to contrast. You may need to take medications before the test in order to safely receive this substance.

 

Before receiving the contrast, tell your health care provider if you take the diabetes medication metformin (Glucophage) because you may need to take extra  precautions.

 

If you weigh more than 300 pounds, find out if the CT machine has a weight limit. Too much weight can cause damage d amage to the scanner's working parts.

 

You will be asked to remove jewelry and wear a hospital gown during the study.

Intratest: Tell the patient that:   The technologist begins by positioning you on the CT examination table, usually lying flat on one's back, on the side or stomach. Straps and pillows may be used to help maintain the correct position and to hold still during the exam.  



If a contrast material is used, it will be injected through an intravenous line (IV) into an arm vein during the procedure. A scan of the lower spine may also be done after injecting contrast material into the spinal canal (usually well below the bottom of the spinal cord) during a lumbar puncture. This will help to detect tumors or locate areas of inflammation or nerve compression.

 Next, the table will move quickly through the scanner to determine the correct starting    position for the scans. Then, the table will move slowly through the machine ma chine as the actual CT scanning is performed.

 

You may be asked to hold your breath during the scanning.

 

When the examination is completed, you will be asked to wait until the technologist determines that the images are of high enough enou gh quality for the radiologist to read.

 

The CT scanning is usually completed within 30 minutes.

 

Most CT exams are painless, fast and easy easy.. With spiral CT, the amount of time that the  patient needed to lie still is reduced.

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 

Though the scanning itself causes no pain, there may be some discomfort from having to remain still for several minutes. If you have a hard time staying staying still, are claustrophobic or have chronic pain, you may find find a CT exam to be st stressful. ressful. The technologist or nurse may offer you a mild sedative to help. h elp.

 

If an intravenous contrast material is used, you will feel a slight prick when the needle is inserted into the vein. A warm, flushed flushed sensation may be felt during the injection of the contrast materials and a metallic taste in your mouth that lasts for a few minutes.

 

When entering the CT scanner, special lights may be used to properly position. You may hear slight buzzing, clicking and whirring sounds as the CT scanner moves during the imaging process.

 

During the CT scan, you will be alone in the exam room, however, the technologist will  be able to see, hear and speak with you at all times.

 

With pediatric patients, a parent may be allowed in the room, but will be required to wear  a lead apron to prevent radiation exposure.

Post test:  

After your CT scan is completed, you may resume all of your normal activities. There should be no ill-side effects and you will be able to drive.

 

The only thing we recommend is that you drink plenty of liquids/water after your  test is complete (if (if given contrast). This is so that the contrast dye can be quickly flushed from your body and you do not become dehydrated.

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  MRI scanning of cervical spine:

 

The technique depicts soft tissue structures well, with reported sensitivities for intervertebral disc injury of 93%, posterior  p osterior  longitudinal ligament injury of 93%, and interspinous ligament injury of 100%.   MRI is indicated for patients with neurological signs, even if plain films are negative.   MRI can distinguish haematoma from oedema, which can have  prognostic importance. NURSING REPONSIBILITIES Pretest  

Make sure the scanner can accommodate the patient’s weight and abdominal girth.

 

Explain to the patient that skeletal MRI assesses bone and soft tissue. Tell him who will  perform the test and where it will take place.   Explain that the test takes 30 to 90 minutes.   Explain to the patient that although MRI is painless and involves no exposure to radiation from the scanner, a contrast medium may be used, depending on the type of tissue being studied. 

  If the patient is claustrophobic or if extensive time is required for scanning, explain to him that a mild sedative may be administered to reduce anxiety. Open scanners have been

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developed for use on the patient with extreme claustrophobia or morbid obesity, but tests using such machine take longer.   An anesthesiologist may need to be present to monitor a heavily sedated pa patient. tient.   Tell the patient that he must lie flat, and describe the test procedure.   Explain to the patient that he’ll hear the scanner clicking, whirring, and thumping as it moves inside its housing.   Reassure the patient that he’ll be able to communicate with the technician at all times.   Instruct the patient to remove all metallic objects, including jewelry, hairpins, or watches.   Stop I.V. infusion pumps, feeding tubes with metal tips, pulmonary artery catheters, and similar devices before the test.   Ask whether the patient has any surgically implanted joints, pins, clips, valves, pumps, or   pacemakers containing metal that could cou ld be attracted to strong MR MRII magnet. If he does, he won’t be able to have the test.  test.     Note and report all allergies.   Make sure that the patient or a responsible family member has signed an informed consent form, if required. Intratest: Tell the patient that:   You may be asked to wear a hospital gown or clothing without metal fasteners (such as sweatpants and a t-shirt). Certain types of metal can cause blurry images.  

You will lie on a narrow table, which slides into a tunnel-shaped scanner.

 

Some exams require a special dye (contrast). The dye is usually given before the test through a vein (IV) in your hand or forearm. The dye helps the radiologist see certain areas more clearly.

 

During the MRI, the person who operates o perates the machine will watch you from ano another ther room. The test most often lasts 30-60 minutes, but may take longer. Post test:   After the test, tell the patient that he may resume his usual activity.

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vii.  MEDICAL MANAGEMENT 

Medication or  Drug Class Methylprednison e

Pharmacological ical Managem Management ent   Pharmacolog

Dosage

Description

30 mg/ kg Corticostero IV as a id loading dose, followed  by a 48 hr  intravenous infusion of  5.4 mg/ kg  per hr 

Rationale Reduces inflammation and improves motor and sensory function

Nursing Responsibility Assess for potassium depletion (fatigue, nausea, vomiting, depression, polyuria, dysrhythmia and weakness). Assess for hypertension, oedema and cardiac symptoms. Assess for mental status. Rotate sites in IM injection. Oral - take with food or milk to decrease GI symptoms.

Inotropic Agents

Varies drugby

Dopamine, Dobutamine

Improve systematic vascular  resistance and  blood pressure



Monitor blood pressure,    pulse, peripheral pulses, and urinary output at intervals  prescribed by physician. Precise measurements are essential for accurate titration of dosage.

 

 

Report the following indicators promptly to  physician for use in decreasing or temporarily suspending dose:

Reduced urine flow rate in absence of hypotension; ascending tachycardia; dysrhythmias; disproportionate rise in diastolic pressure (marked decrease in pulse pressure); signs of peripheral ischemia (pallor, cyanosis, mottling, coldness, complaints of  tenderness, pain, numbness, or burning sensation).   Monitor therapeutic effectiveness. In addition to

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Atropine

1 mg IV as needed

Anticholene rgic

Manage symptomatic  bradycardia

improvement in vital signs and urine flow, other indices of adequate dosage and  perfusion of vital organs include loss of pallor, increase in toe temperature, adequacy of nail bed capillary filling, and reversal of confusion or comatose state.   Take as prescribed, 30 minutes before meals; avoid excessive dosage.   Avoid hot environments; you will be heat intolerant, and dangerous reactions may occur.   You may experience these side effects: Dizziness, confusion caution driving or (use performing hazardous tasks); constipation (ensure adequate fluid intake, proper diet); dry mouth (sugarless lozenges, frequent mouth care may help; may be transient);  blurred vision, sensitivity to light (reversible; avoid tasks that require acute vision; wear sunglasses in bright light); impotence (reversible); difficulty in urination (empty the bladder   prior to taking drug). Report rash; flushing; eye pain; difficulty breathing; tremors, loss of coordination; irregular  heartbeat, palpitations; headache; abdominal distention; hallucinations; severe or persistent dry mouth; difficulty swallowing; difficulty in urination; constipation; sensitivity to light.

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  Surgical Management  

Halo Immobilization  Intervention that restricts flexion-extension motion. Halo vest will

 provide significant but not complete rotational control and is the most effective device for treating unstable injuries to the cervical spine.    Anterior or Posterior Decompression with Fusion   To provide relief of pressure on the cervical spinal cord and nerve roots, and alignment and stabilization of the spine. May involve the use of bone grafts, sometimes combined with metal devices, dev ices, to  produce a rigid connection between two or more adjacent vertebrae.   Cervical Discectomy with or without Fusion Procedure to relieve pressure on one or more nerve roots or spinal cord. It may be performed with or without the use of a microscope.   Cervical Corpectomy Removal of a portion or the entire en tire vertebral body from the front of  the spine. May also include removal of the adjacent discs. Usually involves fusion.   Cervical Laminectomy with or without Foraminotomy or Fusion Surgical removal of the posterior portion of a vertebrae in order to gain access to the spinal cord or nerve roots.   Cervical Laminoplasty Technique that increases anterior or posterior dimensions of the spinal canal while leaving posterior elements partially intact. It may be performed with or without the use of a microscope.   Percutaneous Discectomy An invasive operative procedure to accomplish partial p artial removal of  the disc through a needle which allows aspiration of a portion of  the disc trocar under imaging control.

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viii.  EMERGENCY ACTION PRINCIPLES SCENAREO: One day while driving, the couple Voltaire and Rosvil had an argument inside the car because Voltaire is jealous on o n the co- worker of Rosvil. Just behind them is the car of Mary Mar y Rose.

Rosvil: What are you talking about? Are you insane? Voltaire: Im not stupid Rosvil! I know your having an affair with that guy! Rosvil: Were just friends! How many times do I have to tell you that? Voltaire: Oh really? I see how he looks at you and I know hindi lang kaibigan ang tingin nya sayo. Rosvil: Bahala ka! Your such a paranoid! This Th is conversation is finished dahil tapos na rin tayo! (Voltaire suddenly stopped the car & the car behind bumped their car) 1)  Survey the Scene   Do not look only at the victim; look at the area around the victim (should take a few seconds only). Decide what needs to be done immediately and the order in which will take steps.

  IS THE SCENE SAFE?   Look for anything that may threaten your safety and that of the victim and bystanders like fast moving traffic.



  WHAT HAPPENED?   Look around for clues about what caused the emergency and the type and extent of o f the victim's injuries.   If the victim is conscious, ask specific questions to determine what happened   If the victim is unconscious, look around for clues, the scene itself often gives the answer.   HOW MANY PEOPLE ARE INJURED?   Look carefully for more than one victim because you may not spot everyone at first. An open door of a car may be a clue that a victim is bleeding or screaming loudly, you may overlook  another victim who is silent and unconscious.





  ARE THERE BYSTANDERS THAT CAN HELP?   Bystanders may call emergency professionals for help, meet and direct the ambulance to your location, keep the area free of unnecessary traffic or help you provide care.



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2)  Primary Survey( Primary Assessment) of the victim

  Airway   Open the airway of the unconscious un conscious victim using Jaw Thrust Method.   Breathing   Check for breathlessness( Look- Listen and Feel)   Circulation   Check the carotid pulse   If the person is bleeding severely, control bleeding using u sing direct  pressure. 3)  Shout/ Call for help or Phone Emergency Medical Services System for help if  applicable.   Check for nearest hospital   Make call accurately to include information such as :   Exact location- Old Buswang, Kalibo, Aklan   Callers Name- Mary Rose Inejosa   Telephone Number used- Cell phone number of the caller.   What happened- Accident, A car got bumped on the rear  end.   Number of victims - 2 victims   Victms Condition- Driver is conscious and has minor  injuries, the second victim is unconscious.   The help given- Opened the airway of the unconscious victim and immobilized her head and controlled con trolled the  bleeding of both victims. 









4)  Secondary Survey( Secondary Assessment) of the Victim

  Neorologic Assesment   LOC   Orientation to person, place time and events   Glascow Coma Scale scoring   Pupiullary size, equality, and reaction to light accommodation acco mmodation   Motor movement and strength of hand grips and pedal pulses.   History   Elicit the clients chief complaint   Duration of the problem   Mechanism of injury   Associated manifestations   Past pertinent medical history   Current medication





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 

Use of OTC drugs   Use of alcohol   Known allergies   Immunization history

  Pain



 

Provoke –  Provoke  – factors factors that increase or decrease pain

 

Quality – type Quality –  type of pain   Region/ Radiation- location of pain or movement to other areas   Severity- scale 1-10 to describe pain   Timing- how long the pain has been be en present

  General Overview   Overall health condition   Skin color    Gait   Posture   Head to Toe Focussed Assessment   Head Head –   – laceration, laceration, bruises, fracture, consciousness and mental state   Face- fracture   Eyes Eyes –   – check check for pupil size   Ears and Nose- blood and cs fluids    Neck  –   –   palpate for injury and distended neck veins   Back  –   – vertebral vertebral injury   Chest Chest –   –   breath and heart sounds, deformities, paradoxical motion, tenderness.   Abdomen Abdomen –   – tenderness, tenderness, mass, perforation, intra abdominal injuries   Extremities- fracture and dislocation   Pelvis - fracture and dislocation





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ix.  FIRST AID First Aid for a Severe Injury 

1)  Do not move the person unless his or her life is in danger. If so, log roll the  person, place tape across the forehead, and secure the person to a board to keep neck, and back areas from moving at all. 2)  the Callhead, Ambulance

3)

Check for a response. If giving rescue breaths, do not tilt the head backward. Pull the lower jaw open instead.  

 To I mmobiliz ilize e the He Hea ad, Neck, and/o /orr Ba Bac ck  

  Tell the person to lie still and not move his or her head, neck, back, etc.   Log roll or place rolled towels, etc. on both sides of the neck and/or body. Tie in place,  but don't interfere with the person's breathing. If necessary, necessary, use both of your hands, one on each side of the person's head to keep the head from moving.   Monitor for Bleeding for Bleeding and Shock. Keep the person warm with blankets, coats, etc. e tc.





Mov ove e Someone You Susp Suspe ect H Has as IInj njur ure ed H Hiis or H He er N Ne eck iin n a Di Div ving or Othe Otherr Wat Wate er Accide ccident nt B Be efore E Em merge rgency ncy Care A Arr rriives    Protect the neck and/or spine from bending bendin g or twisting. Place your hands on both sides of  the neck. Keep it in place until help arrives.   If the person is still in the water, help the person float until a rigid board can be slipped under the head and body, at least as far down as the buttocks.





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  If no board is available, get several people peo ple to take the person out of the water. Support the head and body as one unit. Make sure the head does not rotate or bend in any way.



First Aid for Minor Head Injuries  

1)  Put an ice pack or bag of frozen vegetables in a cloth. Apply this to the injured area. Doing this helps reduce swelling and bruising. Change it every 15 to 20 minutes mi nutes for 1 to 2 hours. Do not put ice directly on the skin. Cover an open, small cut with gauze and first-aid tape or an adhesive bandage. 2)  Once you know there is no n o serious head injury, do normal activities again. Avoid strenuous ones. 3)  Take an over-the-counter medicine for pain as directed. 4)  Don't drink alcohol or take any an y other sedatives or sleeping pills. 5)  During the next 24 hours, monitor the person. While asleep, wake the person every 2 hours to check alertness. Ask something the person should know, such as a pet's name, an address, etc. If the person can't be roused or respond normally, get immediate medical care.

If You Suspect a Whiplash Injury 

1)  See your doctor, as soon as you can, to find out the th e extent of injury. If your arm or hand is numb, let your doctor know. 2)  For the first 24 hours, apply ice packs to the injured area for up to 20 minutes every hour. 3)  After 24 hours, use ice packs or heat, he at, whichever works best, to relieve the pain. There are many ways to apply heat. Take a hot shower for 20 minutes a few times a day. Use a hotwater bottle, heating pad (set on low), or heat he at lamp directed to the ne neck ck for 10 minutes, several times a day. (Use caution not to burn the skin.) 4)  Wrap a folded towel around the neck to help hold the head in one position during the night.

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Use a cervical neck pillow or a small rolled towel behind your neck instead of a regular   pillow. First Aid For Traffic Accidents  

1)  If the person was in a motorcycle accident, do not remove the helmet. Call 9-1-1 to do this. 2)  Don't move the person. He or she may have a spinal injury. Call 9-1-1 to do this. First Aid for Bleeding from the Scalp 

1)  To control bleeding, put pressure around the edges of the wound. Make a ring pad (shaped like a doughnut) out of long strips of cloth to apply pressure around the edges of  the wound. If this doesn't control bleeding, put pu t direct pressure on the wound. Don't poke your hand into the person's brain, though. 2)  Don't wash the wound or apply an antiseptic or any other fluid to it. 3)  If blood or pink-colored fluid is coming from the ear, nose, or mouth, let it drain. Do not try to stop its flow.

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x.  HEALTH TEACHINGS   Prevention   Prevention of accidents: personal responsibility when driving, safe roads, avoiding alcohol before driving.   Properly fitted headrests play a major role in preventing or o r reducing the severity of  whiplash injuries.   Laser-initiated braking systems can prevent collisions and intelligent seat design can halve the rate of neck injury if an accident occurs.   Prevention of sports injuries, particularly contact sports.   Prevention of falls in the elderly.  elderly.  



Protect yourself and your family by:  

Always wearing a seatbelt   Supervising children and adolescents who are swimming and diving in lakes and pools   Using the proper equipment and training during athletic participation   If a significant neck injury does occur, be sure to contact your local emergency medical services for help.

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IV.  11 AREAS OF NURSING RESPONSIBILITY RESPONSIBILITY A.  Safe and Quality Nursing Care   Survey the scene first, safety is considered when providing p roviding emergency care for the victim.   Make quick but accurate nursing decision in relation to victims.   Position the victim on his back and in flat position for proper  implementation of jaw thrust. B.  Management of resources and Environment   Utilize things at the site that can be used as an improvised collar to immobilize the neck of the victim.   Make use of bystanders if there’s if  there’s any, by asking them to call for help or to help in giving first aid. C.  Health Education   Provide health teachings to the victim with cervical spine injury.   Instruct the folks to report any signs and symptoms of  D.  Legal Responsibility   The legal right of the patient to receive information from appropriate treatment alternatives for his or her condition.   The right to make decisions regarding the health h ealth care that is reccomendwd  by the physician.   The right to courtesy, respect, dignity, responsiveness responsiven ess and timely attention to health needs of the patient.   The right to confidentiality.   The right to continuity of care.   The basic right to have adequate health care. E.  Ethico- Moral Responsibility   The nurse has the legal responsibility to report to the authority what has happened.   The nurse has legal responsibility to monitor the victim and watch for  complications that may occur.   Avoid further harming the patient. F.  Personal and Professional Development   Communicates with other health care providers for the continuity of care of the patient.   Demonstrate confident leadership qualities in this emergency situation. G.  Quality Improvement   Share with the team relevant information regarding clients condition.   Give objective on what was observed rather than interpretation of the event.

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H.  Research   Utilize findings in research regarding the provision of nursing care o individuals, group and families.   Make use of evidence based nursing I.  Records Management   Complete updated documentation of client care  

Records should be readily accessible to facilitate client care.   Observe confidentiality and privacy of client’s records.  records.     Organize system filling J.  Communication   Create trust and confidence   Spend time with client or significant others and other members of health care team to facilitate interaction.   Utilize effective channels of communication relevant to client care management.   Provide therapeutic touch, warmth and comforting words of  encouragement.  

Proper channel communication should be observed for treatment of the client. K.  Collaboration and Teamwork    Contribute to decision making regarding clients need or concerns   Respect the role of the other members of the health care team   Acts as a client advocate   Maintains good interpersonal relationship with clients, colleagues and other members of healthcare team.

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V.  CONCLUSION Regardless of the cause, cervical spine fractures are serious injuries, they may involve spinal cord damage that can result in partial or complete paralysis or even death. At the end of  this presentation we, the BSN IV- B Group 6 students will be able to show in a form of role  playing the emergency treatment or interventions to be b e rendered to a patient suspected of having havin g a cervical spine injury. This presentation will equip us with the needed information and knowledge concerning emergency nursing nu rsing especially with regards to cervical spine injury. The presentation can give additional learning for those who are in the medical field and for those who are lay people, so when the time comes when they are confronted with the scenario, they will know what to do.

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VI.  REFERENCES BOOKS

Black, Joyce M., Jane Hokanson Hawks. “Medical - Surgical Nursing: Clinical Management for  th

 Positive Outcomes”. 8 Ed. Vol.2. Singapore: Elsevier, Inc. 2008. rd

Gould, Barbara E., “Pathophysiology for the Health Professions”. 3 Edition. Singapore: Elsevier, Inc. 2007. Johnson, Susan A., Marilyn Sawyer Sommers. “Diseases and Disorders: A Nursing  nd Therapeutics Manual ”. 2 Ed. Phildelphia:  Phildelphia: F.A. Davis Company.2002. McVan, Barbara, et al. “Illustrated Manual in Nursing Practice”. Springhouse, Pennsylvania: Giuani Prints House, 1998.

INTERNET http://emedicine.medscape.com/article/824380-clinical http://emedicine.medscape.com/article/824380-followup http://emedicine.medscape.com/article/824380-overview#a0101 http://emedicine.medscape.com/article/824380-overview#a0199 http://emedicine.medscape.com/article/824380-overview#aw2aab6b2b3 http://emedicine.medscape.com/article/824380-overview#a0104 http://emedicine.medscape.com/article/824380-overview#aw2aab6b2b4 http://emedicine.medscape.com/article/824380-overview#aw2aab6b2b5 http://emedicine.medscape.com/article/824380-overview#aw2aab6b2b6 http://emedicine.medscape.com/article/824380-overview#aw2aab6b2b7 http://emedicine.medscape.com/article/824380-overview#aw2aab6b2b8 http://emedicine.medscape.com/article/824380-overview#aw2aab6b2b9 http://emedicine.medscape.com/article/824380-treatment http://emedicine.medscape.com/article/824380-treatment#a1126

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http://emedicine.medscape.com/article/824380-treatment#a1129 http://emedicine.medscape.com/article/824380-workup http://firstaid.ygoy.com/2011/07/19/first-aid-for-a-cervical-spine-injury/ http://www.healthy.net/scr/Article.aspx?Id=1286 http://www.hughston.com/hha/a.cspine.htm http://www.spineuniverse.com/anatomy/cervical-spine-anatomy-neck 

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