Flashcards in EAC Injuries to the Pelvis and Spine Deck (17):
3 causes of pelvic injury
Direct force pelvic injury
When a bone breaks at the point where the force is applied i.e. crush or impact injury
Indirect force pelvic injury
When the bone breaks at some distance from the point where force has been applied i.e. heavy landing on feet damaging pelvis
Muscular action pelvic injury
Where there is violent contraction of muscles often pulling the pelvis out of alignment
signs and symptoms of:
(these being present may indicate use of Prometheus Pelvic Splint PPS)
Severe pain from the back of the pelvis
Inability to stand
Rigidity of abdomen (internal bleeding)
Legs in an unnatural position
Feeling of pelvic cavity lying 'open' or 'falling apart'
High index of suspicion based on mechanism and/or other associated injuries
Abnormal mobility to pelvic region
Urge to pass urine
Blood in patients urine
Bruising or swelling over the bony prominences, pubis, perineum or scrotum.
Leg length discrepancy or rotational deformity of a lower limb (without fracture in that extremity) may be evident.
Wounds over pelvis or bleeding from rectum, vagina, urethra may indicate an open pelvic fracture.
Altered sensation in one leg.
Ensuring open airway
Administering high % O2
Relieving pain with Entonox
Warning the pt not to pass urine; doing so may tear the bladder as it empties
Making the pt comfortable and providing support to the injury
Avoiding 'springing' the pelvis, as this may cause catastrophic bleeding
Using plenty of padding
Immobilising the knees and ankles to prevent movement of the legs
Constantly reassuring and observing pt
Provide a smooth journey to hospital
Major blood vessels
Organs i.e. bladder, urethra, reproductive organs
location of the Greater Trochanter
primary landmark needed to use PPS
The boney prominence on the lateral aspect hip
NOT the iliac crest which is too high.
roughly where pt's wrist will lay if pt's arm is lain by their side.
Application of the Prometheus Pelvic Splint PPS
Apply PPS in conjunction with scoop to avoid rolling pt twice.
Bright yellow side on outside
Black side against pt's skin
PPS placed in L shape and passed under the pt by method of log roll no more then 10 degrees tilt.
Place blue triangle of one side over greater trochanter and cut splint to length (approx. line of blue triangle). Then same on other side.
Two staff either side of pt to pull tabs up and away from pt. taking care not to over compress the pelvis.
The tabs are then secured to the wide yellow band.
Secure feet with triangular bandage.
Can be used in conjunction with the Kendrick Traction Splint if there is a concurrent fractured femur. PPS applied 1st.
CAN NOT be used with the sager traction splint
Prometheus Pelvic Splint can be used...
ONCE - single use device
3 types of Spinal Injury
Dislocation of the vertebrae
Fracture of the vertebrae
Displaced intervertebral disc
Injury to the Spine
Damage to spinal cord
Compression of spinal cord
Cauda Equina syndrome
Cauda Equina syndrome
The Cauda Equina (Latin for "horse's tail") is a bundle of spinal nerves and spinal nerve roots.
This is a 'Spinal Emergency'. It occurs when the nerves below the spinal cord are compressed. The nerves that supply the bladder and bowels also supply sensation to the skin around the bottom and back passage.
red flags associated with:
Any of the following are significant in the presence of lower back pain and/or unilateral or bilateral lower limb pain, radiating from the lower back:
Numbness in the groin/perineum/buttocks
Bladder or bowel dysfunction
Lower limb weakness and/or sensory deficit (disturbed gait/inability to walk)
Reduced or absent lower limb reflexes
signs and symptoms of:
As well as usual signs and symptoms of fracture:
Loss of feeling or sensation in the body below the site of injury
Tingling, or pins and needles sensation above the site of injury
Paralysis below the site of injury often accompanied by loss of internal muscle control which causes incontinence
Displacement of a spinal vertebrae felt as an unnatural lump, or depression, from the normal continuity of the spinal column
fixation of the spinal column at the site of the injury
diaphragmatic or abdominal breathing
ensuring an open airway by jaw thrust and maintaining a neutral alignment position
High % O2 (major trauma)
supporting the head and neck and applying a cervical collar.
Consider HEMS/BASICS etc
Transfer to hospital with pre-alert if time critical
If time permits; carrying out a secondary survey to establish the site of injury
consider the use of Entonox to relieve pain and other analgesia
handling slowly and carefully to avoid any jarring or rotation of the head and lower limbs
avoiding rotation or angulation of the spine
Immobilising the lower limbs at the knees and ankles
securing upper limbs to prevent movement
applying a spinal board
lifting the pt carefully using specialist lifting equipment and avoiding and unnecessary movement
positioning the pt with adequate spinal support
conveying slowly and smoothly taking account of adverse road conditions
Get a thorough History of the accident and the mechanism of injury
Do not rush unless life is in obvious danger