First aid for spinal injury

The closed trauma of the spine and spinal cord is not more than 0.3% of the total number of all injuries.

There are three groups of closed spinal injuries.

1. Spine injury without damaging the contents of the spinal canal.

2. Damage to the spine, spinal cord and ponytail.

3. Damage to the spinal cord only.

Open spinal injuries are those in which the integrity of the skin is disturbed. Isolate penetrating damage( violation of integrity of the dura mater) and non-penetrating( the dura mater is not damaged).

Clinical forms of lesions of the spinal cord: concussion, bruising, compression, hematomyelia( haemorrhage into the substance of the spinal cord, over-and under-embolic hemorrhages, epidural and subarachinal hemorrhages, traumatic radiculitis).Given the pathologoanatomical features of spinal cord trauma, one should keep in mind the possibility of crushing a brain substance with partial disruption of the anatomical integrity of the spinal cord, compression of the spinal cord and its roots.

Spinal cord concussion - reversible functional changes in the type of over-limit inhibition.

Clinically, the concussion of the spinal cord is characterized by the reversibility of the pathological changes that have occurred. These are transient paresis, paralysis, transient disorders of pelvic organs. 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 several minutes and hours to 2-3 weeks( depending on the severity of the shock).The contusion of the spinal cord is a combination of pathomorphological changes( necrosis, hemorrhage, etc.) with functional changes.

Immediately after a spinal cord injury, paralysis occurs, pareses that occur with muscle hypotension, areflexia, a sensitivity disorder, a dysfunction of the pelvic organs. With a serious injury, a different degree of recovery occurs by the third week, with significant anatomical lesions - to 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 the fragments by the arms of the vertebral bodies;

• hernial traction of intervertebral discs;

• metal foreign bodies;

• epidural hematomas.

In case of damage to the upper cervical spine( I-IV cervical vertebrae) spasm paralysis of all four limbs develops, loss of all sensitivities, pelvic disorders. When involved in the process of brain stem processes, bulbar symptoms develop, respiratory disorders, cardiovascular disorders, vomiting, hiccups, and swallowing disorders.

In case of damage to the inferior part( cervical thickening, level of V-VII cervical vertebrae) flaccid paralysis of upper extremities develops and spastic paralysis of the lower extremities develops;note the loss of all kinds of sensitivity below the level of damage, radicular pain in the upper limbs. Damage of the thoracic region is accompanied by lower spastic paraplegia, lower paranesthesia, pelvic disorders. When the lumbar injuries( level X-XII thoracic and I lumbar vertebrae) develops flaccid paralysis of the lower extremities, pelvic disorders. Early cystitis and pressure ulcers appear. Sometimes the syndrome of an acute abdomen develops. Damage to the horse's tail is accompanied by peripheral paralysis of the lower extremities, loss of sensitivity on the lower extremities and in the perineal region, root pain in the legs, cystitis, pelvic disorders, and pressure ulcers. The preservation of arbitrary contractions of individual muscles below the estimated level of damage to the spinal cord excludes an anatomical break and indicates partial damage.

First aid .The main thing is immobilization of the spine, which should prevent the displacement of broken vertebrae;Do not allow the spinal cord to be compressed or re-traumatized during transport;prevent damage to the vessels of the spinal canal and the formation of extra- and intrastinal hematomas. Immobilization of the spine should be carried out in a position of moderate extension.

In the case of neck injuries, a massive cotton-gauze bandage is applied to the neck at the scene of the accident, preventing the head from tilting to the sides and forward. It is best to fix the cardboard wadded collar of Shantz. A very reliable fixation of the cervical vertebrae and head is carried out by the Bashmakov bandage with the help of two Cramer ladder tires laid in mutually perpendicular planes.

With damage to the thoracic and lumbar spine, the patient is placed on a shield - any hard surface. The shield is covered with a blanket. If there is no possibility to create a firm surface or in the lumbar region a large wound, the injured person is placed on the usual soft stretcher on the abdomen. Under the chest and pelvis, rollers from a folded blanket, rucksack, etc. are inserted.

With simultaneous damage to the spinal cord, the injured person must be tied to a stretcher to prevent passive movements of the trunk during transportation and additional displacement of the damaged vertebrae. To transfer such victims follows three together: one holds a head, the second brings arms under a back and a loin, the third - under a basin and knee joints. Raise the patient all at once on command, otherwise it is possible dangerous bending of the spine and additional trauma.

Before immobilization, intramuscular injections of analgin solutions of 1% 1 ml with a strong pain syndrome - a solution of promedol 2%

1 ml or morphine 1% 1 ml, omponone 2% 1 ml. With open trauma of the spine, gently treat the wound with solutions of hydrogen peroxide, furacilin, apply an aseptic napkin, which is well fixed with adhesive plaster. The injured person is hospitalized in a hospital with a neurosurgical unit.