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Fakultas Kedokteran
Universitas Hasanuddin
Makassar
2015
Insiden
10,000 - 20,000 ditemukan pasien
dengan trauma tulang belakang tiap
tahunnya di seluruh dunia.
Insiden
~ 82% ditemukan pada pria
~ 61% ditemukan pada umur 16-31 tahun
Penyebab tersering
MVC (48%)
Falls (21%)
Penetrating injuries (15%)
Sports injuries (14%)
Prevention
Edukasi dalam penanganan primer
(handling
and
movement)
dapat
menurunkan tingkat kejadian SCI
Primary Injury Prevention
Public Education
EMS Community Service Projects
Anatomi
33 Vertebrae
Spine supported by pelvis
key ligaments and muscles connect head to
pelvis
anterior longitudinal ligament
anterior portion of the vertebral body
major source of stability
protects against hyperextension
Anatomy Review
Bone Structure
of the Spine
Cervical
Lumbar
Thoracic
Sacral/Coccyx
Anatomi
Cervical
7 vertebrae
very flexible
C1: also known as the atlas
C2: also known as the axis
Thoracic
12 vertebrae
ribs connected to spine
provides rigid framework of thorax
Anatomy
Lumbar Spine
5 vertebrae
largest vertebral bodies
carries most of the bodys weight
Sacrum
5 fused vertebrae
common to spine and pelvis
Coccyx
4 fused vertebrae
tailbone
Anatomy Review
Vertebral body
posterior portion forms part of
vertebral foramen
increases in size from cervical to sacral
spinous process
transverse process
Vertebral foramen
opening for spinal cord
Intervertebral disk
shock absorber (fibrocartilage)
Anatomi
Berakhir di ~ L-2
cauda equina
Blood supplied by vertebral and
spinal arteries
Gray matter: core pattern\
resembling butterfly
White matter: longitudinal bundles
of myelinated nerve fibers
Anatomy Review
Spinal Cord
Thoracic and lumbar levels supply
sympathetic nervous system fibers
Cervical and sacral levels supply
parasympathetic nervous system
fibers
and
conveys
nerve
impulses
for
proprioception,
discriminative touch, pressure, vibration, & twopoint discrimination
cross over at the medulla from one side to the other
e.g. impulses from left side of body ascend to the right
side of the brain
Anterior tracts
carry impulses of light touch and pressure
Picture
Motor Cortex
Brain
Stem
Posterior
column
Corticospinal
tract
Spinal
Cord
LMN
Pain - Temp
Proprioception
(conscious)
Spinal Nerves
31 pairs originate from the spinal cord
Carry both sensation and motor function
Named according to level of spine from
where they arise
Cervical 1-8
Thoracic 1-12
Lumbar 1-5
Sacral 1-5
Coccygeal 1
Plexus
peripheral nerves rejoin and
function as group
Cervical Plexus
LEVEL
SENSATION
MOTOR
REFLEX
C5
Deltoid
Biceps
C6
Lateral forearm
Brachioradialis
C7
Middle finger
Triceps
C8
Small finger
Finger flexors
None
T1
Medial arm
Interossei
None
LEVEL
SENSATION
MOTOR
REFLEX
L1
Anterior thigh
Psoas (T12,L1,L2,L3)
None
L2
Quadriceps (L2,L3,L4)
None
L3
Quadriceps (L2,L3,L4)
None
L4
Tibialis anterior
Patellar
L5
None
S1
Gastroenemius, peroneals
Achilles
S2-24
Perianal
None
MEKANISME
Indikasi lainnya
Decreased LOC in trauma patient
Pain in spine or paraspinal area
Pain in back of head, shoulders, arms,
legs
Absent, altered sensation (numbness,
paresthesias, loss of temperature,
position, touch sense)
Absent,
altered
motor
function
(weakness, paralysis)
Indikasi lainnya
Diaphragmatic breathing
(paralysis of chest wall)
Shock with slow heart rate and
dry skin
Incontinence
Priapism
Cardiovascular impairment
Neurogenic Shock
Hypoperfusion
Priapism
Excessive Movement
acceleration
deceleration
deformation
Directional Forces
flexion, hyperflexion
extension,
hyperextension
rotational
lateral bending
vertical compression
distraction
Secondary Injury
occurs after initial
injury
may result from
swelling/inflammati
on
ischemia
movement of body
fragments
Cord compression
decompression required to minimize
permanent injury
Laceration
permanent injury dependent on degree of
damage
Hemorrhage
may result in local ischemia
Terminology
Paraplegia
loss of motor and/or sensory
function in thoracic, lumbar
or sacral segments of SC
(arm function is spared)
Quadriplegia
loss of motor and / or
sensory function in the
cervical segments of SC
(sPinal cord)
Exam Findings
Flaccid-type paralysis of lower body
Bladder and bowel impairment
Picture 2
Neurogenic Shock
Temporary loss of autonomic function of
the cord at the level of injury
Usually results from cervical or high thoracic
injury
Neurogenic Shock
Presentation
Flaccid paralysis distal to injury site
Loss of autonomic function
Management of SCI
Primary Goal
Prevent secondary injury
Management of SCI
Neutral positioning of head and
neck if at all possible
allows for the most space for cord
most stable position for spinal column
dont force it
Management of SCI
Cervical Motion Restriction
Manual method
Rigid collar comes later
Interim device (KED)
Move to long board or full body vacuum splint
Manual continues until trunk and head secured
CID
Dont use sand bags or IV fluid bags as head blocks
Tape works wonders!
Improvise with blanket rolls
Management of SCI
Dont forget the Padding
Maintains anatomical position
Limits movement on board
especially during transport on board or in
vehicle
Management of SCI
Securing to the Board
Straps, Tape, Cravats, whatever
Torso first
then legs and feet and head
Management of SCI
Pediatric Patient Considerations
Elevate the entire torso if large occiput
Pad underneath
Short board underneath
Vacuum mattress
Management of SCI
Helmeted Patients
Removal should be limited to emergent need
for access to airway and ventilation
Leave in place if
good fit with little or no head movement within
no impending airway or breathing problems
can perform spinal motion restriction with helmet on
no
interference
in
airway
assessment
or
management
no cardiac arrest
Management of SCI
Helmeted Patients
Types of Helmets
Sports (football, hockey)
Shoulder pads and helmet go together
Racing (motorcycle, car racer)
Recreational (motorcycle, bicycle)
Various
helmets
create
different
problems for patient and for removal
Management of SCI
General
Manual Spinal Motion Restriction
ABCs
Increase FiO2
Assist ventilations prn
IV Access & fluids titrated to BP ~ 90-100 mm Hg
Thank You