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Emergency Care of Acute Head and Cervical Spine Injuries

For further information, please visit the NATA Position Statements links provided below:

C-Spine Stablization

If a spinal injury is suspected, then activation of EMS should take place. Do not move the patient until EMS has arrived to assist in the spine boarding of the patient. Spine boards are designed to maintain head and neck alignment along with full-body immoblization. In order to maintain limited motion of the cervical spine, it is important for one person to be designated to maintaining head and neck immoblization. 

 

Note: Proper spine boarding should only be done by trained professionals. Improper spine boarding procedures can cause further harm to the patient if done incorrectly.

 

The following steps should be taken to ensure limited motions of the athlete.

  • The examiner should immediately maintain the position of the cervical spine upon arrival at the scene

  • The examiner must determine whether the patient is breathing and has a pulse

  • A spine board is retrieved for moving the patient

  • If the patient is lyng prone, he/she must be logrolled onto his/her back for CPR or to be secured to the spine board. A patient with a possible cercial fracture is trasported face up. A patient with a suspected spinal fracture is the lower-trunk area may be transported face down.

  • If the patient is wearing a helmet with a face mask, the face mask should be removed to allow access to the airway prior to spine boarding. However, if the patient is prone, he/she should be logrolled onto a spine board before removing the face mask. 

  • The spine board should be place close to the side of the patient

  • to roll the athlete over requires at least fice persons, with the captian of the team protecting the patient's head and neck. the neck must be stabilized and must not be moved from its original position, no matter how ditorted it appears.

  • All extremities are placed in an axial alignment.

  • Each assistant is responsible for one of the patient's body segments (trunk, hips, thighs, lower legs)

  • With the spine board close to the patient's side, the captian, gives the command to logroll him or her onto the board as one unit.

  • On the board, the patinet's head and neck continue to be stablized by th captian while the face mask is removed.

  • Next, the head and neck are stabilized on the spine board by a chin strap, head strap, and side blocks.

  • Finally, the trunk and lower limbs are secured to the spine board by straps.

  • The rescures place themselves in a position to stand, and then, on the command of the captian, they collectiviely lift the patient on the spine board.

  • The spine board can then be carried to a transport vehicle or cart for removal from the field.

Cervical spine injuries occur with structural distortion of the cervical spinal column and is associated with actual or potential damage to the spinal cord. Sudden death can occur if the damage is both severe enough and at a high enough level in the spinal column (above C5) to affect the ability to transmit respiratory or circulatory control from the brain.

 

PREVENTION

  • Be familiar with sport-specific causes of catastrophic cervical spine injuries and understand the physiologic response in the spinal cord. 

  • Educate about the mechanisms of catastrophic spine injuries and prevention. 

  • Helmets should be properly maintained and undergo regular reconditioning and recertification. 

  • EMP should be familiar with proper athletic equipment removal to minimize motion. 

RECOGNITION

  • Presence of any of the signs or symptoms requires initiation of spine injury management protocols. 

    • Unconsciousness or altered level of consciousness, bilateral neurologic finding or complaints, significant midline spine pain with or without palpation, or obvious spinal column deformity.

 

Equipment-Laden Athletes

  • Primarily acute treatment goals are to ensure the c-spine is immobilized and neutral, and that vital life functions are accessible. 

  • Removal of helmet and should pads in any equipment-intensive sport should be deferred unless the helmet is not properly attached to prevent movement of the head, the equipment prevents neutral alignment of the c-spine, or the equipment prevents airway or chest access. 

  • Full face-mask removal using proper tools and techniques is executed once the decision to immobilize and transport has been made. 

  • Physician or AT should accompany athlete to hospital. 

  • Remaining equipment should be removed by trained professional in ER. 

 

Return to Play

  • Highly variable and may be permitted only after complete tissue healing, neurologic recovery and clearance of a physician.

  • Factors include level of injury, type of injury, number of levels fused fro stability, cervical stenosis, and activity. 

 Spine Boarding

Concussion Management

Concussions are defined as a trauma-induced alteration in mental status that may or may not invovle the loss of conscuousness (NATA Concussion Management Position statment, 2014).

 

For evaluating a patient with a possible concussion, the examiner should follow the HOPS assessment, with checking vitals and ABC's occuring first and foremost.

 

History

The purpose of the history, espeically in acute injuries, is to determine if the athlete has sustained a concussion. If the athlete has loss consciousness and/or if any amnesia is present are clear indications of a concussion. It is important to ask questions the examiner knows the answer to in order for an accurate assessment.

Example questions for this assessment are:

  • Can you remember what happened?

  • Can you remember the score?

  • Can you remember who we played last week?

  • Do you have any neck pain? 

  • Can you move your hands and feet?

 

Observation

Knowing the patient has an advatange in determining a concussion in order to determine if any abnormal behavior is occuring. Usually, signs and symptoms of a concussion include:

  • Disorented and unable to tell where he/she is, the time, date, or their opponent

  • A blank or vacant stare. Difficulty keeping eyes open.

  • Slurred or incoherent speech.

  • Delayed verbal and motor responses

  • Gross coordination disturbances

  • Unable to focus attention or easily distracted

  • Memory deficitency with repeating questions

  • Abnormal cognitive functions

  • Abnormal emotional responses

  • Clear or straw colored fluids (Halo Test if blood is present)

 

Palpation

Palpation of the neck and skull should be done in order to identify any areas of point tenderness or deformity.

 

Special Tests

All suspected concussion cases should undergo a neurological exam in order to assess the cranial nerves and normal sensory/motor function. In addition, eye funtion tests, balance tests, coordination tests, and cognitive tests should be included to assess the head for any additional damages.

Retrieved November 14th, 2014 from: https://www.youtube.com/watch?v=tO0JdbZeRxo

Retrieved November 14th, 2014 from: https://www.youtube.com/watch?v=m4PlL0d5TlA

Information retrieved from:

Douglas, J. C., Guskiwicz, K. M., Anderson, S. A., Courson, R. W., Heck, J. F., Jimenez, C. C., McDermott, B. P., Miller, M. G., Stearns, R. L., Swartz, E. E., Walsh, K. M. (2012) National athletic trainers' association position statment: Preventing sudden death in sports. Journal of athletic training, 47(1): 96-118. Retrieved from: www.nata.org/jat

Guskiewicz, K. M., Bruce, S. L., Cantu, R. C., Ferrara, M. S., Kelly, J.   P., McCrea, M., Putukian, M., Valovich, T. C. (2004). NATA  position statement: Management of sport-related concussion.  Journal of Athletic Training. 39(3), 280-297.

Prentice, W.E. (2011). Principles of Athletic Training: A Comprehensive-Based Approach. Boston, MA: McGraw Hill

Swartz, E., Boden, B., Courson, R., Decoster, L., Horodyski, M., Norkus, S., Rehberg, R., Waninger, K. (2009). National athletic trainers' association position statement: Acute management of the cervical spine injured athlete. Journal of athletic training, 44(3):306-331. Retrieved from: www.nata.org/jat

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