Spinal injury is considered one of the most common types of injuries human body. The nature of injury is greatly influenced by physiological and anatomical features spine. So, in young people, injuries of this nature are much less common than in older people and account for 3 to 10% of all injuries to the musculoskeletal system. Any spinal injury is classified as severe injury. In addition, such injuries are combined with damage to other anatomical structures, such as the spinal cord, neurovascular plexuses. Such injuries most often lead to disability and pose a serious threat to human life.
The spine can be damaged in various ways: falling from high altitude, car accident, heavy lifting. Such injuries can lead to sprains spinal ligaments, displacement of intervertebral discs, or fracture of the spinal column. The last type of injury is considered the most serious because it leads to damage spinal cord And irreversible consequences. In any case, first aid should be provided. If the nature of the injury is in question, it is better to play it safe and treat the victim as if there was a spinal fracture.
Damage to the spine is heterogeneous and can have different localization, severity and clinical manifestations. Injuries to the cervical, thoracic, lumbar, sacrum, and coccyx are more common; skin lesions may also be present or absent. It should be noted that the higher the injury, the more severe the violation.
When the spine is damaged, there are following symptoms, which depend on the degree of damage and the location of the injury:
In more severe cases, with a spinal fracture, spinal shock is observed, which is characterized by disruption of the activity of the reflex centers of the spinal cord, paralysis of the limbs, and disturbances of the bladder and intestines.
Of course, it is not always possible to be nearby at the time of injury. qualified doctor or a health worker, but first aid has to be provided to a person without medical education. Therefore, it is very important to know several rules for providing first aid, on which the life of the victim and the result of further treatment depend.
How to provide first aid for spinal injuries
In most cases, spinal injury is accompanied by acute pain and complete or partial immobility. To provide competent first aid, you need a group of people, at least 3 people. You need to call immediately ambulance, then carry out the following activities:
- give if possible;
- move the victim as little as possible;
- carefully place him on a stretcher;
- monitor breathing, in cases of shock or cardiac arrest, perform indirect cardiac massage and artificial respiration;
- in case of injuries to the cervical spine, you need to secure a collar made from improvised means in the neck area;
- in case of injury to the thoracic or lumbar spine, the victim must be placed on a hard surface and a cushion placed under the injury site;
- if a person is conscious, you need to cover him with a blanket and give him a warm drink;
It is very important to transport the patient correctly; the further state of his health depends on this.. To transport the patient you will need at least 3 to 5 people. Stretchers can be made from available materials; they must have a flat surface. It is not allowed to place any pillows or bolsters under the injured spine; the victim must lie flat on his back. After the ambulance arrives, you need to report all the actions that were carried out before their arrival.
Injury or fracture of the spine is very dangerous for human health, therefore it is very important to follow all pre-medical first aid measures.
Correctly provided first aid for spinal injuries can save motor activity victim and significantly reduce the rehabilitation period.
What should you do if you have a spinal injury? Seek medical attention immediately. Check air access. However, keep in mind that if the spine is injured, any movement of the head, neck or back can cause or worsen paralysis and even be fatal.
This means that, while providing air access, you cannot tilt or turn the victim’s head even slightly. You can only raise your chin a little, see if there are any foreign objects in your mouth, and if there are, remove them.
Then feel your pulse and listen to your breathing. If there is no pulse or the person is not breathing, proceed to indirect massage hearts.
How to help a conscious victim? Ask if he feels numbness, tingling, weakness or burning in his arms and legs, and if he can move his arms, legs, feet, or fingers.
Ask in detail what happened. If you suspect the victim has a back injury, do not move him. Wait for the ambulance to arrive.
How to help someone in unconscious? Don't move it! Place rolled blankets, towels, and clothing on the sides of the body, head, and neck to prevent movement and further injury to the spinal cord. Make sure the victim's body is lying straight.
Do not give the victim anything to drink. Make sure his neck doesn't turn.
What are doctors doing? Doctors will immediately immobilize you to immobilize your spine and prevent further injury to the spinal cord. For example, the victim may be placed on a long board.
Maintenance of vital functions
If damaged nervous system breathing, blood pressure, heart rhythm and temperature may be affected; Physicians should closely monitor for life-threatening changes. A heart monitor and IV are installed to administer medications and fluids. Oxygen is used to support breathing. Special blankets or a heating mattress may be needed to maintain warmth.
Restoring breathing
If the upper part of the spinal cord is damaged, the victim may be unable to breathe and will need mechanical ventilation to save their life.
If the injury is slightly lower, on the neck, the person can breathe, but in this case respiratory distress cannot be ruled out. Doctors should closely monitor breathing.
Possibility of spinal shock
Trauma to the spine can cause spinal shock. Wherein blood pressure falls and the pulse slows down. Used to increase pressure intravenous infusion medications and saline solution.
Treatment of cracks
For a small crack, only a hard “collar” may be needed. The patient will receive painkillers and muscle relaxants until the crack heals (about 10-12 weeks). Special exercises will help strengthen your back muscles. When walking, the back will be supported by a corset.
Neck fracture treatment
For a neck fracture, external cranial traction is used to immobilize the head and neck for up to three months. In this case, the head is fixed with clamps, ropes, counterweights and other devices.
Surgery
Surgery may be necessary if there is compression of the spinal cord or a fracture of the vertebra that cannot be corrected in any other way. During the operation, part of the slab bone is attached to the adjacent vertebra.
After the operation, a plaster cast is applied and the patient is placed on a special bed, which helps avoid bedsores during prolonged immobility.
What else do you need to know
If a back injury results in permanent paralysis, the patient will need long-term care and special equipment. For example:
- wheelchair;
- special devices for eating;
- mechanical fan;
- clothes that are comfortable to wear.
Adaptation: assistance in rehabilitation
Rehabilitation measures are aimed at helping a paralyzed person adapt to life after illness. These include:
- empathy;
- assistance in adjusting to addiction and changes in body image;
- training in special toilet skills;
- help in achieving meaningful goals.
J. Zeccardi
"What to do if you have a spinal injury"- article from the section
Spinal fractures are a very dangerous injury; they are fraught with the development of paralysis. Spinal fracture in Shane or thoracic region can lead to respiratory and circulatory arrest (since signals from the brain will not reach the heart and pulmonary muscles). In this case it will help artificial respiration.
If you suspect a spinal injury (back or neck), do not try to move the victim. On the contrary, the main task of first aid for a spinal injury is to ensure that the victim remains, as far as possible, until the ambulance arrives in the same position in which he was found.
Spinal injury can be suspected if:
There are signs traumatic brain injury
- The victim complains of severe pain in the neck or back
- The injury was associated with a significant blow to the back or head.
- The victim complains of weakness, numbness or impaired motor function of the limbs; paralysis of limbs; Loss of bladder or bowel control.
- The neck or back looks “twisted” or is in an unnatural position.
If an emergency arises (for example, if a new danger threatens the victim), he should be placed face up on a hard surface (on a wide board, a door removed from its hinges, or a wooden board) and tied so that he does not move while moving. This must be done by two or three people. 
If a person is unconscious, then he is placed on his stomach, placed under the upper part chest and forehead rolls, to avoid suffocation with a sunken tongue or inhalation of vomit.
During transportation, the victim is fixed to a board or stretcher.
IN CASE OF DAMAGE TO THE CERVICAL SPINE
the victim is laid on his back on a hard surface, and the head and neck are fixed from the sides with two rolls made of rolled up clothes, blankets, pillows. If a fracture of the cervical spine is suspected, the neck and head are immobilized using a soft gauze circle, improvised materials. A soft circle of cotton wool or another soft material is placed on a stretcher, the victim’s head is placed on a circle so that the back of the head is inside the circle, and head movements are limited. Sometimes it is possible to apply a bandage to the neck in the form of a Shants collar. Such a bandage should limit mobility in the cervical spine, but not impede breathing and blood circulation.
Shants collar
Cervical fixation
PP FOR MAXILLOFACIAL WOUNDS, DAMAGE TO THE EYES, NOSE, EAR, NECK.
Maxillofacial wounds.
Signs of damage to the maxillofacial area are determined by the nature of the damage. With closed injuries, pain, swelling, bruising, deformation of the bones of the facial skull, difficulty opening the mouth, and sometimes facial asymmetry are observed. With penetrating wounds, there is often heavy bleeding from the wound to the outside or into the oral cavity, salivation, difficulty in taking food and water, signs of asphyxia due to displacement of the tongue or jaw fragments, closure of the upper respiratory tract a blood clot, a foreign body, developed edema or hematoma of the larynx and trachea.
The appearance of late hemorrhages on the face usually indicates damage to the deeper parts of the face, bones of the base of the skull, and orbit.
At heavy bleeding Acute anemia occurs, and in case of severe injuries, shock occurs.
First aid for maxillofacial injuries.
When providing first aid to victims with damage to the maxillofacial area
a number of features must be taken into account: the impossibility of using conventional individual gas masks, discrepancies between the appearance of the injuries and the severity of the injury, the presence of heavy bleeding, the constant threat of asphyxia, the undesirability of applying pressure bandages, impaired swallowing in victims and the inability to eat.
Wounded in maxillofacial region it is necessary to actively search, since due to damage and injury to the face, jaws and tongue, the wounded have impaired speech and they cannot call for help. In addition, in 20% of cases, such victims experience concussions and bruises of the brain with loss of consciousness.
A sterile bandage must be applied to facial wounds, while hanging flaps of soft tissue of the face must be carefully placed in place. This helps maintain tissue position, quickly stop bleeding and reduce tissue swelling. It should be borne in mind that in case of fractures of the jaws and facial bones, applying a pressure bandage is dangerous, since displacement of bone fragments can occur with undesirable consequences.
Threatening bleeding is stopped as a temporary measure by finger pressure carotid artery to the transverse processes of the cervical vertebrae, followed by applying a bandage to the wound.
When evacuating the injured, it is necessary to ensure systematic monitoring of the bandage, its correction and bandaging. In winter, if the bandage is saturated with blood and saliva, it should be replaced to avoid frostbite on the face. A wet bandage when frozen makes it difficult for the victim to breathe. The tasks of first aid include: to prevent asphyxia - dislocation (from displacement of the tongue and jaw fragments) and aspiration (aspiration of blood, mucus and vomit). To do this, the victim is placed face down or on his side.
In case of a fracture of the lower jaw, dislocation of the tongue is eliminated by applying a sling-shaped fixing bandage to the lower jaw, which eliminates displacement of the fragments.
Rice. 79. Sling-shaped bandages: a - on the nose; b - on the chin; c, d - to the parietal and occipital regions
In cases of retraction or danger of retraction of the tongue, it can be quickly and well fixed using safety pin from an individual package, with a pin piercing the tongue from top to bottom or from left to right, then a thread is tied to it. The thread is tied to the upper teeth, or tied to a bandage wrapped around the neck or chest.
The injured should be evacuated without delay. Most of them, if there was no concussion, can be sent on foot, some can be transported while sitting, and only about 15-20% need to be evacuated on a stretcher.
Dislocation of the lower jaw.
Dislocation of the mandible in the mandibular joint is most common in older people, mainly women. Bilateral dislocation is more common.
Characteristic feature dislocations of the mandibular joint is that they usually occur without much external force, but only as a result of excessive movements in the joint itself, for example, from opening the mouth too much during yawning, vomiting, tooth extraction, etc.
Recognizing dislocations of the mandibular joint does not cause difficulties, since appearance is very typical for such patients. The lower jaw is displaced downward and anteriorly, the mouth does not close, the cheeks are flattened, teeth are impossible to bite, saliva is released profusely from the mouth, and speech is unclear. At the usual place of the articular head of the lower jaw, anterior to the auricle, there is a recess. Herself articular head of the lower jaw is palpated under the zygomatic arch. With unilateral dislocation listed signs less pronounced. The lower jaw is slightly shifted in the direction opposite to the dislocation.
First aid consists only of referring the patient to a doctor. No bandage is required. The doctor reduces the dislocation. When corrected correctly, the jaw, with a characteristic clicking sound, is set in normal position. After the reduction, you should avoid opening your mouth wide, chewing hard foods, yawning, etc. for several days, that is, give the joint rest.
Traumatic eye injuries.
Eye damage is associated with exposure to mechanical energy, high temperature, light radiation /especially during a nuclear explosion/, acids, alkalis and others chemical substances/OV/.
When injured, various damage to the eyelids, conjunctiva, and cornea can occur. Perforated wounds of the eyeball are classified as severe and are often combined with injuries to the orbit, nose and other areas of the head.
Signs of injuries include the appearance of pain in the eye, swelling and hemorrhage under the skin and conjunctiva, the presence of foreign bodies, lacrimation, photophobia, clouding of the cornea, in severe cases, loss of the inner membranes of the eye, even complete destruction of the eyeball.
When providing first aid, an aseptic bandage is applied to the eye; foreign bodies in the conjunctiva and cornea of the eye are most often in the form of grains of sand, particles of coal and metal. In this case, an acute burning sensation, lacrimation, and photophobia arise in the eye. Foreign bodies are removed with a cotton swab or, better yet, with a piece of cotton wool wound on a stick and moistened with a solution of boric acid or another solution. Foreign bodies are removed from the cornea by a doctor using eye instruments.
Thermal burns to the eyes are not significantly different from thermal burns to the skin. Light burns occur when there is strong bright light, such as electric welding. Signs of burns are sharp, sharp pain in the eyes and photophobia, which occurs suddenly a few hours after irradiation, redness of the conjunctiva, lacrimation, eyelid spasms, and sometimes decreased visual acuity.
First aid consists of cold lotions. Then treatment is carried out by instilling the eyes with dicain, rinsing boric acid. Be sure to wear dark glasses.
Chemical burns eye problems occur when exposed to acids and alkalis. A scab is formed with the subsequent rejection of dead tissue, and a scar or thorn appears in this place.
First aid consists of constantly and abundantly rinsing the eyes with a stream of water and applying a dry, clean bandage. If a foreign body is inserted into eyeball, then it cannot be removed. It should be carefully covered with a soft cloth, a sterile bandage applied and taken to a medical facility as soon as possible. Extract foreign body DO NOT do it on your own!!!
If the eyelid comes off, it is washed, placed in a sterile napkin and fixed in the forehead area. Subsequently, the victim undergoes plastic surgery.
Traumatic ear injuries.
Ear damage is rarely isolated. More often, especially with gunshot wounds, they are combined with injuries to the eye socket, jaws or brain. Particularly severe damage occurs with gunshot wounds and as a result of exposure to explosive, shock waves. nuclear explosion. Signs of damage are wounds, tinnitus, decreased hearing, bleeding from the ear, pain when moving the lower jaw, sometimes dizziness, nausea, vomiting, and leakage of clear brain fluid. First aid consists of applying an aseptic bandage. If the ear or part of it is torn off, the damaged part of the body is washed, placed in a sterile napkin and fixed behind the ear. Subsequently, plastic surgery is performed.
Traumatic injuries to the nose.
Damage to the nose can be isolated or in combination with damage to the adnexal maxillary cavities. Signs of damage include pain, nosebleeds, bruising, changes in the shape of the nose, and sometimes facial emphysema.
First aid consists of stopping nosebleeds and applying an aseptic bandage. Minor nosebleeds can often be stopped by placing the victim in a sitting or semi-sitting position with his head slightly tilted forward. Coldness is applied to the nose and the wings of the nose are pressed against the septum. If possible, a tampon moistened with a solution of calcium chloride and hydrogen peroxide is inserted into the nose.
NOSE BLEED
Nose bleed may be the result of injury, bleeding disorders, hypertension and other diseases, or occur during severe physical exertion
First aid for nosebleeds:
1. It is convenient to sit the patient so that the head is higher than the body;
2.Tilt the patient’s head slightly forward so that blood does not enter the nasopharynx and mouth;
3.If you have a nosebleed, you should not blow your nose, because... this may increase bleeding!
4.Press the wing of the nose to the septum. Before this, you can insert cotton swabs into the nasal passages, dry or moistened with a 3% solution of hydrogen peroxide, naphthyzine 0.1% (tampons are prepared from cotton wool in the form of a cocoon 2.5-3 cm long and 1-1.5 cm thick, for children - 0 .5cm);
5.Put cold on the back of the head and bridge of the nose (ice pack) for 20 minutes.
When should you consult a doctor?
· If the blood from the nose “flows in a stream” and does not stop after attempts to stop on its own within 10-20 minutes;
· If, in addition to nosebleeds, there are diseases such as blood clotting disorders, diabetes, increase blood pressure;
· If the patient constantly takes medications such as aspirin, heparin, ibuprofen;
· If blood flows profusely down the back wall pharynx, i.e. gets into the throat and arises bloody vomiting;
· If you experience fainting or near-fainting due to nosebleeds;
· For frequently recurring nosebleeds.
Further treatment of nosebleeds is carried out by an ENT doctor in
Damage to the neck, trachea, larynx, pharynx and esophagus.
First aid for them.
Penetrating injuries of the larynx and trachea are accompanied by shortness of breath, paroxysmal cough, hemoptysis, and the release of foamy blood, impaired swallowing, phonation disorder (hoarseness, hoarseness, aphonia).
If the wound channel is not wide enough, exhaled air comes out with difficulty and penetrates into subcutaneous tissue neck and mediastinum compresses the larynx, trachea, large vessels, leading to suffocation with serious consequences.
A wound to the pharynx is accompanied by painful swallowing, release of saliva and food from the wound, respiratory failure, sometimes with the development of asphyxia due to swelling of the epiglottis. Isolated penetrating wounds of the cervical esophagus are very rare; more often, a combination of injuries to the esophagus and neighboring organs is observed.
Pain, difficulty swallowing, leakage of saliva and mucus from the wound, subcutaneous emphysema are the most common symptoms of penetrating injury to the cervical esophagus. First aid for injuries to the pharynx, larynx and esophagus consists of applying an aseptic bandage. If there is a gaping wound to the larynx and trachea through which the wounded person breathes, a bandage is not applied, but instead a gauze curtain is attached to the neck. The wounded must be urgently sent to medical institution in a sitting position with the head tilted forward or in a position on the side (but not on the back). If injury to the esophagus is suspected, the wounded should not be given food or water.
Large wounds blood vessels neck injuries result in life-threatening bleeding. Such wounded people often die at the scene of injury. If the neck veins are damaged, an air embolism may occur. Wound thyroid gland is also often accompanied by significant bleeding.
First aid for damage to large vessels includes finger pressure on the bleeding vessel or wound tamponade. Can be used pressure bandage, tourniquet according to Mikulich's method.
4. APPLICATION TECHNIQUE bandages on one and both eyes, a Neapolitan bandage on the ear, a “bonnet” bandage, sling-shaped bandages on the nose and chin, a cruciform bandage on the back of the head and neck, a “bridle” bandage.
A vertebral injury is very dangerous, so it is forbidden to move the victim. Improper transportation can cause irreversible paralysis and various serious complications.
A spinal injury is considered a serious injury.
First aid for a spinal injury should be provided in a timely, careful and correct manner.
Closed spinal herbs are divided into 3 groups:
- The injury is not accompanied by damage to the contents of the spinal canal.
- Spinal injury with damage to the spinal cord and cauda equina.
- Injury exclusively to the spinal cord.
At open injuries there is a violation of the integrity of the epithelium. If the spine is injured, there may be crushing of the brain matter, compression of the spinal cord and its roots.
Click on the picture to enlarge
- symptoms characteristic of traumatic brain injury;
- change in level of consciousness;
- inability to turn the neck;
- manifestation severe pain in the area of the back, neck;
- the back and neck are in an unnatural position;
The most obvious symptoms indicating injury to any part of the spine are acute pain and complete (partial) immobility.
A spinal fracture is a serious injury that requires medical attention.
Symptoms of a fracture:
- there is tension in the back muscles;
- spontaneous release of urine and feces occurs;
- pain is noted on palpation;
- the neck is in an unusual position;
- paralysis of limbs.
First aid
If such symptoms are present, first aid should be started. emergency care. First aid in case of a spinal fracture consists of performing the following actions:
- Establishing the degree of injury to the victim.
- If necessary, provide the victim with an anesthetic.
- Eliminate transportation without the need and necessary equipment.
- The victim is transported carefully on a stretcher.
- It is necessary to monitor the patient's airway.
- If the cervical spine is injured, immobilization should be performed using a special collar, which is attached to the neck area.
- If the injury is located on the chest, lumbar region spine, the victim should be placed on a hard surface on his back. Place a roller under the damaged area.
- If the victim is conscious, it is advisable to carry out anti-shock therapy (provide him with warm drinks, cover him with a blanket, warm clothes).
- Transportation of the victim should be as careful as possible.
- Emergency care for a spinal injury should be provided by several people (3–5 people). This is necessary in order not to harm the victim.
- Call an ambulance.
Cervical injury
Cervical spine injury accounts for about 20% of all spinal injuries. The mortality rate for such an injury is 35–44%. The most common injuries are to the 5th and 6th cervical vertebrae. The most common cervical injuries are:
- dislocations;
- fractures;
- fracture-dislocations.
Most cervical spine injuries occur as a result of indirect violence. The following mechanisms of violence are distinguished:
- flexion;
- extensor;
- compression;
- flexion-rotation.
Emergency care for cervical injuries should be provided by a group of specialists, which includes: a trauma surgeon, a neurosurgeon, an anesthesiologist, and a neurologist.
When transporting a victim with a cervical spine injury, it is necessary to use a Shants cardboard-wadding collar and a Bashmakov bandage to fix the head.
Skull fracture
The danger of skull injury increases due to the likelihood of injury to the brain, blood vessels, and meninges. Brain injury from a skull injury can be caused by the following factors:
- impact of the brain on the skull bone;
- pressing bone fragments into brain tissue;
- compression of the brain under the influence of blood leaking into the skull.
Both open and closed fractures. If professional help is not provided in the next minutes or hours, the injury will end fatal. Brain injury and changes in intracranial pressure provoke a malfunction of the nervous system. Everything is vitally disrupted important functions(breathing, heartbeat).
Symptoms of a skull fracture:
- change in the shape of the skull;
- crunching on palpation in the area of the fracture;
- bleeding from the mouth, ear, nose;
- formation of hemorrhages in the eyes, nose, pharynx, ears.
These symptoms indicate the presence of a skull fracture. The victim must be examined by a specialist.
In addition to such pronounced symptoms, the following symptoms may appear:
- hearing, vision impairment;
- loss of consciousness;
- headache;
- dysfunction of the facial muscles;
- vomit;
- loss of speech;
- breathing problems;
- paralysis of limbs.
Providing first emergency aid in the presence of a skull fracture consists of performing the following actions:
- Place the victim on his back.
- If necessary, perform resuscitation measures.
- Apply a sterile bandage to the wound.
- It is forbidden to set or remove bone fragments from the wound.
- The neck needs to be fixed.
- Give painkillers if the victim is conscious.
- The head should take a stable position. Fixing the head and neck reduces injury to the victim during transportation.
- When transferring the victim onto a stretcher, it is necessary to keep the head and neck in a stable position.
- When vomiting, the patient should be turned with the whole body, and not in the cervical region.
Damage to the spine leads to unpredictable consequences and often leads to disability or death. What is important to know and how to provide first aid?
According to statistics, the portrait of a victim with a spinal injury is a middle-aged man. In old age, men and women are affected with equal frequency. Childhood injuries occur much less frequently; these are mainly birth injuries.
What are the types of spinal column injuries?
By the nature of the traumatic factor, one can determine what type of damage the injury belongs to.
Damaged in car accidents and motorcycle drivers cervical region. The so-called whiplash occurs when braking: first a sharp bend, and then an equally sharp throw of the head back. Women have slightly weaker muscles and therefore are more likely to suffer from whiplash.
The cervical spine is injured by people who dive carelessly.
A fall from a height is a combination of fractures of the lower thoracic and pelvic regions. Power types Sports and heavy lifting are also among the causes of injury.
According to the location of the damage, they are divided into the following: fracture of the cervical spine, thoracic, lumbar, sacral, coccyx.
By nature: bruises, articular tears and ligament ruptures, fractures of the spinous and transverse processes, arches and vertebral bodies, dislocations, subluxations, displacements. It is clinically important to divide injuries into uncomplicated and complicated (spinal cord injury).
The angle and force that are directed give another classification:
- Wedge-shaped fracture. The integrity of the vertebral body membrane is compromised. It takes on a wedge shape. It is treated conservatively.
- Wedge-comminuted. The vertebra is completely damaged and the intervertebral disc is damaged. Requires surgical treatment, a possible complication in the form of spinal cord damage.
- Fracture-dislocation. The vertebral body is destroyed. The ligamentous apparatus and disc are damaged. Requires surgical intervention. Possible damage to the spinal cord.
- Compression. Vertical crack in the vertebral body. Treatment depends on the degree of separation of bone fragments.
Signs of a bruise: the patient feels diffuse pain. Swelling and bruising, loss of sensitivity, and impaired motor functions are found at the site of injury.
The cause of a bruise can be a fall in bad weather, incompetent diving, an accident, or a blow with a blunt object.
Symptoms of distortion (stretching): acute pain, limited movement, and the phenomenon of radiculitis may occur. This injury usually occurs after abruptly lifting a heavy object.
With dislocations and subluxations of the vertebrae, acute pain appears, the victim has a forced position of the head or torso, and movements are sharply limited.
Symptoms for fractures and fracture-dislocations depend on the severity and location of the injury. This is pain in the back and neck. muscle cramps, weakness, numbness of the arms and legs.
The victim may have difficulty walking or lose movement of their limbs completely (paralysis).
First aid at the prehospital stage
From the first moments, if the head and spine are damaged, the victim must be given first aid and taken to a medical facility. Any self-treatment may be dangerous to health and life.
As careful as possible, it includes several stages:
- place the victim face up on a hard surface, do not allow him to sit down or stand up;
- Roll up a roll of fabric and carefully secure the neck area;
- carry and hold the body at the same level;
- do not shift the patient unnecessarily;
- do not leave it unattended;
- observe consciousness, pulse and breathing;
- immediately call an ambulance or transport the victim to a medical facility yourself.
Principles of therapy in health care facilities
Providing first aid in a medical institution includes: constant monitoring of pulse, blood pressure, administration of supportive medications.
Further treatment is carried out using immobilization, traction using special devices, corsets, and collars.
Surgical intervention is performed in case of incomplete transverse spinal lesions, with preserved symptoms of the nerve roots and with extensive spinal deformity.
It is important that the consequences of back injuries are largely determined by the length of time from the moment of injury to the start of treatment. Almost always, inadequately provided first aid worsens the course of the victim’s illness. Treatment is a complex, lengthy stage at which traumatologists, neurosurgeons and rehabilitation specialists work. They determine the prognosis for a person’s future life and performance.
Additional sources:
- Selected lectures on traumatology Polyakov V.A. Section: Orthopedics and traumatology. Library www.MEDLITER.ru - electronic medical books.
- Clinical lectures on emergency traumatology Girshin S.G. Section: Orthopedics and traumatology. Library www.MEDLITER.ru - electronic medical books.
- Multiple and combined injuries Sokolov V.A. Section: Orthopedics and traumatology. Library www.MEDLITER.ru - electronic medical books.
Be healthy!
Closed trauma to the spine and spinal cord makes up no more than 0.3% of the total number of all injuries.
There are three groups of closed spinal injuries.
1. Damage to the spine without damage to the contents of the spinal canal.
2. Damage to the spine, spinal cord and cauda equina.
3. Damage to the spinal cord only.
Open spinal injuries are those in which the integrity of the skin is compromised. There are penetrating injuries (violation of the integrity of the dura mater) and non-penetrating (dura mater) meninges not damaged).
Clinical forms of spinal cord lesions: concussion, contusion, compression, hematomyelia (hemorrhage into the substance of the spinal cord, supra- and intrathecal hemorrhages, epidural and subarachnoid hemorrhages, traumatic radiculitis). Considering the pathoanatomical features of spinal cord injury, one should keep in mind the possibility of crushing the brain matter with partial disruption of the anatomical integrity of the spinal cord, compression of the spinal cord and its roots.
Spinal concussion- reversible functional changes of the type of extreme inhibition.
Clinically, spinal cord concussion is characterized by the reversibility of the onset pathological changes. We are talking about transient paresis, paralysis, transient disorders of the pelvic organs. The disappearance of pathological phenomena, when the patient can be considered practically recovered (this is the clinical difference between a concussion and a bruise), occurs from a few minutes and hours to 2-3 weeks (depending on the severity of the concussion). Spinal cord contusion is a combination of pathomorphological changes (necrosis, hemorrhage, etc.) with functional changes.
Immediately after a spinal cord injury, paralysis and paresis occur, accompanied by muscle hypotonia, areflexia, sensitivity disorders, and dysfunction of the pelvic organs. In case of severe injury varying degrees recovery occurs by the 3rd week, with significant anatomical damage - by 4-5 weeks.
Spinal cord compression. Due to the fact that the spinal cord is located in the bone canal, it can be compressed by:
Closed and gunshot fractures of the spine with displacement of fragments by the arches of the vertebral bodies;
Hernial extension of intervertebral discs;
Metal foreign bodies;
Epidural hematomas.
In case of damage to the upper cervical region (I-IV cervical vertebrae) spastic paralysis of all four limbs, loss of all types of sensitivity, and pelvic disorders develop. When the brain stem is involved in the process, bulbar symptoms, respiratory distress, cardiovascular disorders, vomiting, hiccups, difficulty swallowing.
If the lower cervical region is damaged (cervical thickening, level of the V-VII cervical vertebrae), flaccid paralysis of the upper extremities and spastic paralysis of the lower extremities develops; note loss of all types of sensitivity below the level of damage, radicular pain in upper limbs. Damage thoracic accompanied by lower spastic paraplegia, lower paraanesthesia, and pelvic disorders. If the lumbar spine is damaged (level X-XII thoracic and I lumbar vertebrae), flaccid paralysis develops lower limbs, pelvic disorders. Cystitis and bedsores appear early. Sometimes a syndrome develops acute abdomen. Damage to the cauda equina is accompanied by peripheral paralysis lower extremities, loss of sensitivity in the lower extremities and in the perineum, radicular pain in the legs, cystitis, pelvic disorders, bedsores. The preservation of voluntary contractions of individual muscles below the expected level of spinal cord damage excludes an anatomical break and indicates partial damage.
Urgent Care. The main thing is immobilization of the spine, which should prevent displacement of broken vertebrae; prevent compression of the spinal cord or re-traumatization during transportation; to prevent damage to the vessels of the spinal canal and the formation of extra- and intra-trunk hematomas. The spine should be immobilized in a position of moderate extension.
In case of injuries to the cervical spine, a massive cotton-gauze bandage is applied to the neck at the scene of the incident, preventing the head from tilting to the sides and forward. Shantz's cardboard-wadding collar provides the best fixation. Very reliable fixation of the cervical vertebrae and head is carried out with a Bashmakov bandage using two Kramer ladder splints applied in mutually perpendicular planes.
In case of injuries to the thoracic and lumbar spine, the patient is placed on a backboard - any hard surface. The shield is covered with a blanket. If it is not possible to create a non-flexible surface or in the lumbar area big wound, the victim is placed on a regular soft stretcher on his stomach. At the same time, bolsters from a folded blanket, backpack, etc. are placed under the chest and pelvis.
If the spinal cord is simultaneously damaged, the victim must be tied to a stretcher in order to prevent passive movements of the torso during transportation and additional displacement of the damaged vertebrae. There should be three people to shift such victims: one holds the head, the second puts his hands under the back and lower back, the third - under the pelvis and knee joints. Everyone lifts the patient at the same time on command, otherwise dangerous flexion of the spine and additional injury are possible.
Before immobilization, 1% analgin solutions (1 ml) are injected intramuscularly with strong pain syndrome- solution of promedol 2%
1 ml or morphine 1% 1 ml, omponone 2% 1 ml. For open spinal injuries, carefully treat the wound with solutions of hydrogen peroxide, furatsilin, apply an aseptic napkin, which is well fixed with an adhesive plaster. The victim is hospitalized in a hospital with a neurosurgical department.
Spinal trauma is one of the most severe injuries to the body, which is due to the complexity of its structure, its large extent, and the high functional significance of both itself and the structures contained in it. Injury can develop as a result of both chronic and acute exposure. In the latter case, the prognosis largely depends on the correct provision of first aid to the victim.
Signs and characteristics of acute spinal injury
- Injuries to the cervical spine are very dangerous, accounting for up to 20% of all spinal injuries. A peculiar type, characteristic only of the cervical spine, is a “whiplash” injury, when, during sudden braking of a moving vehicle, a push is transmitted to a person sitting in the cab. In this case, the appearance of acute pain in the cervical spine and limited head mobility are typical.
- Most injuries to any part are characterized by acute pain or the inability to move in the spine.
- Spinal fractures can damage the spinal cord, causing paralysis of the limbs and pelvic organs.
First aid rules depend on the nature of the damage
- In any situation, you must call an ambulance as soon as possible!
- If it is necessary to move or examine the victim, he must be laid on a hard, flat surface (asphalt or ground).
Do not carry the victim in your arms or on a blanket! This may worsen his condition.
Your actions:
- Carefully place the victim on a flat surface.
- Avoid arching your spine.
- If the cervical spine is fractured, fix it by placing a thick layer of cotton wool on the neck, which can be secured, for example, with a newspaper folded into a collar.
- Place pillows or bundles of clothing under your neck and shoulders.
- Call an ambulance medical care for hospitalization of the victim in the traumatology department.
This information is provided to you for educational purposes only. For specific advice regarding diagnosis and treatment of a medical condition, consult your doctor.
