Emergency Live | 10 Steps to perform a Correct Spinal Immobilization of a Trauma Patient image 4 — Thaum muaj xwm ceev xyaum: daim ntawv thov ntawm lub taub hau immobilizer thiab ntawm lub ncauj tsev menyuam dab tshos

Cervical and spinal immobilization techniques: Kev piav qhia

By Cristiano Antonino On Feb 24, 2023

Cervical and spinal immobilization techniques: Cov kev pab kho mob xwm txheej ceev (EMS) cov neeg ua hauj lwm tseem yog cov neeg saib xyuas tseem ceeb hauv kev tswj xyuas cov xwm txheej tawm hauv tsev kho mob feem ntau, suav nrog cov xwm txheej raug mob.

ATLS (advanced trauma life support) cov lus qhia, tsim nyob rau xyoo 1980s, txuas ntxiv ua tus qauv kub rau kev ntsuam xyuas thiab saib xyuas qhov tseem ceeb ntawm kev tswj hwm kev raug mob rau lub neej raws li kev xav thiab ua tau zoo, txawm hais tias muaj kev sib cav ntev ntev txog cov txheej txheem. ntawm kev siv cov kev pab no.

Spinal immobilization tau yog ib feem tseem ceeb ntawm kev qhia, ntxiv rau pelvic binders thiab splints rau cov pob txha ntev.

Ntau hom kev kho mob cov khoom tau tsim los ua kom muaj txiaj ntsig zoo thiab yooj yim ntawm daim ntawv thov, nrog rau kev tso cai yooj yim thiab tseem ceeb rau kev tswj hwm txoj hlab cua thiab lwm yam txheej txheem.

Qhov yuav tsum tau immobilize tus txha nraub qaum yog txiav txim siab los ntawm qhov xwm txheej thiab kev ntsuas tus neeg mob.

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xav txog spinal immobilisation thaum lub mechanism ntawm kev raug mob tsim ib tug siab Performance index ntawm suspicion rau lub taub hau, lub caj dab los yog raug mob qaum

Kev puas siab puas ntsws thiab kev puas siab puas ntsws tsis zoo kuj yog qhov qhia tau tias tus txha caj qaum yuav tsum raug txiav txim siab.[1][2][3][4]

Kev qhia ATLS ib txwm siv rau kev tsim nyog tus txha caj qaum immobilisation ntawm tus neeg mob nyob rau hauv qhov xwm txheej tseem ceeb yog qhov ua tau zoo nruj ntseg tsho nrog cov blocks thiab daim kab xev kom ruaj ntseg ntawm lub ncauj tsev menyuam qaum, nrog rau lub nraub qaum los tiv thaiv tus txha nraub qaum.

cov Kendrick extrication ntaus ntawv tso cai rau tus txha nraub qaum tiv thaiv nrog tus neeg raug mob nyob rau hauv ib qho chaw zaum thaum lub sij hawm ceev extrication ntawm lub tsheb los yog nyob rau hauv lwm lub sij hawm qhov kev nkag tau txwv kom tso cai rau siv tag nrho cov backboard.

Txawm li cas los xij, cov cuab yeej no xav kom cov neeg ua haujlwm cawm seej saib xyuas kom txwv kev txav ntawm lub ncauj tsev menyuam txha caj qaum los ntawm kev siv inline mobilization kom txog thaum sib dhos [5].

10th tsab ntawm ATLS cov lus qhia thiab cov lus pom zoo ntawm American College of Emergency Physicians (ACEP), American College of Surgeons Committee on Trauma (ACS-COT), thiab National Association of EMS Physicians (NAEMSP) hais tias, hauv Cov ntaub ntawv ntawm kev raug mob nkag mus tsis muaj qhov qhia txog kev txwv kev txav ntawm tus txha caj qaum [6], nyob rau hauv txoj kab nrog kev tshawb nrhiav rov qab los ntawm American Trauma Database uas pom tias muaj pes tsawg tus neeg mob tsis ruaj khov uas xav tau kev phais hauv cov ntsiab lus ntawm kev raug mob. Txoj kev tshawb no tseem qhia tau hais tias tus naj npawb ntawm cov neeg mob yuav tsum tau kho kom tau txais txiaj ntsig zoo dua li cov neeg mob yuav tsum tau kho kom tau txais kev raug mob, 1032/66.

Txawm li cas los xij, nyob rau hauv rooj plaub ntawm kev raug mob loj heev, kev txwv txuas ntxiv tau qhia hauv cov xwm txheej hauv qab no:

Tsawg GCS los yog pov thawj ntawm cawv thiab yeeb tshuaj intoxication
Midline lossis posterior cervical spine tenderness
Pom tseeb spinal deformity
Kev pom ntawm lwm yam mob uas cuam tshuam

Cov lus pom zoo rau kev txwv tsis pub muaj txiaj ntsig txuas ntxiv yog lub ncauj tsev menyuam caj dab nrog kev tiv thaiv tus txha caj qaum, uas yuav tsum tau muab tshem tawm sai li sai tau.

Qhov no yog vim muaj kev pheej hmoo ntawm kev raug mob ntau txheej.

Txawm li cas los xij, hauv cov menyuam yaus, qhov kev pheej hmoo ntawm kev raug mob ntau theem yog tsawg thiab yog li ntawd tsuas yog kev ceev faj ntawm lub ncauj tsev menyuam thiab tsis muaj kev tiv thaiv kab mob tag nrho (tshwj tsis yog muaj cov tsos mob lossis cov tsos mob ntawm lwm yam kev raug mob qaum).

Cervical immobilization thiab rigid dab tshos nyob rau hauv ib tug me nyuam tus neeg mob

caj dab mob
Kev hloov ntawm limb neurology tsis tau piav qhia los ntawm limb trauma
Muscle spasm ntawm caj dab (torticollis)
Tsawg GCS
Muaj kev pheej hmoo raug mob (xws li lub tsheb sib tsoo lub zog siab, kev raug mob hyperextension ntawm lub caj dab thiab qhov tseem ceeb ntawm lub cev raug mob)

Thaj chaw ntawm kev txhawj xeeb

Muaj cov pov thawj loj hlob tuaj thiab txhawj xeeb txog qhov chaw ntawd triage tau coj mus rau kev siv tus txha caj qaum immobilisation ntau dhau thiab tias qee cov neeg mob muaj feem pheej hmoo[7][8][9][10].

Tej yam teeb meem ntawm spinal immobilisation:

Tsis xis nyob thiab nyuaj siab rau tus neeg mob [11].
Kev ncua sij hawm ua ntej tsev kho mob nrog kev ncua sij hawm ntawm kev tshawb nrhiav thiab kev kho mob tseem ceeb, nrog rau kev cuam tshuam nrog lwm yam kev cuam tshuam [11].
Kev txwv tsis pub ua pa los ntawm cov hlua khi, nrog rau kev ua pa tsis zoo nyob rau hauv txoj hauj lwm supine piv rau txoj hauj lwm upright. Qhov no yog qhov tseem ceeb tshwj xeeb tshaj yog nyob rau hauv cov xwm txheej ntawm thoracic raug mob, txawm hais tias blunt los yog nkag mus [12] [13] nyuaj nrog intubation[14].
Cov ntaub ntawv ntawm cov neeg mob uas muaj ankylosing spondylitis los yog pre-existed spinal deformity, qhov twg tiag tiag yuav tshwm sim los ntawm kev yuam tus neeg mob kom ua raws li predetermined txoj hauj lwm ntawm lub ncauj tsev menyuam txha caj dab thiab nraub qaum [15].

Kev tshuaj xyuas tshiab ntawm Scandinavian cov ntaub ntawv, tau ua los tshuaj xyuas cov pov thawj muaj rau kev txwv tsis pub txav ntawm tus txha caj qaum [16], muab kev nkag siab zoo heev rau kev sib piv ntawm prehospital spinal stabilization txoj kev nrog kev ntsuam xyuas ntawm lub zog ntawm cov pov thawj.

Rigid dab tshos

Lub caj dab txhav tau siv txij li nruab nrab xyoo 1960 los ua ib txoj hauv kev ntawm lub ncauj tsev menyuam txha nraub qaum, nrog cov pov thawj tsis zoo txhawb nqa nws cov txiaj ntsig zoo ntawm qhov tshwm sim ntawm lub paj hlwb raug mob ntawm ncauj tsev menyuam, nrog rau cov teebmeem tsis zoo vim muaj qhov nce hauv intracranial siab thiab dysphagia [17].

Tsab ntawv xov xwm tseem qhia tias tus neeg mob ceeb toom thiab koom tes nrog cov leeg nqaij leeg tshwm sim los ntawm qhov raug mob tsis zoo li yuav muaj kev hloov pauv tseem ceeb, raws li tau sau tseg hauv cov kev tshawb fawb cadaver uas tau sim los kawm txog kev raug mob.

Tsab ntawv qhia txog kev ntsuas qhov txaus ntshai thiab cov txiaj ntsig ntawm qhov kev phais no.

Txawm li cas los xij, American Association of Neurological Surgeons txuas ntxiv qhia cov dab tshos nruj raws li txoj hauv kev kom ruaj khov ntawm lub ncauj tsev menyuam qaum hauv qhov xwm txheej ua ntej tsev kho mob [18].

Rigid board: Thaum twg yog tus txha caj qaum longboard siv?

Thawj tus txha caj qaum longboard tau siv ua ke nrog lub caj dab nruj, thaiv thiab cov hlua kom ua tiav immobilisation ntawm tus txha nraub qaum.

Tej zaum kev puas tsuaj, tshwj xeeb yog mob siab rau ntawm lub sacrum, [19][20] tau tshwm sim tam sim no, tshwj xeeb tshaj yog nyob rau hauv cov ntaub ntawv ntawm tus txha caj qaum tsis muaj kev tiv thaiv.

Lub tshuab nqus tsev ntxhua khaub ncaws muaj lub ntsej muag zoo nkauj uas tiv thaiv qhov tshwm sim ntawm qhov mob siab thiab tib lub sijhawm muab kev txhawb nqa txaus thaum txuas mus rau saum taub hau theem [16].

blocks

Blocks yog ib feem ntawm inline mobilization lub tswv yim rau stabilizing tus txha nraub qaum thiab zoo li zoo thaum strapping tus neeg mob mus rau tus txha caj qaum. Rooj Tswjhwm Saib cov kom ua tiav ib qho degree ntawm immobilisation, tsis muaj qhov txiaj ntsig ntxiv ntawm kev siv lub dab tshos nruj ua ke [21].

Nqus txaj

Muab piv rau lub tshuab nqus tsev pam pua chaw nrog lub rooj tsav tsheb nruj ib leeg, lub txaj pw muaj kev tswj xyuas ntau dua thiab tsis tshua muaj zog thaum lub sij hawm thov thiab nqa dua li lub rooj tsav tsheb nruj [22].

Nrog rau kev pheej hmoo ntawm kev mob siab, lub txaj zoo li muaj kev xaiv zoo dua rau kev thauj neeg mob.

Tso cov nqaj qaum: kev hloov kho ntawm tus txha caj qaum thiab ncauj tsev menyuam immobilization

Cov txheej txheem NEXUS: ib qho kev ceeb toom, tus neeg tsis haus luam yeeb yam tsis muaj kev cuam tshuam kev raug mob muaj qhov tshwm sim tsawg heev ntawm kev raug mob thaum tsis muaj midline nro thiab neurological tsis txaus.

Qhov no zoo nkaus li yog cov cuab yeej tshuaj ntsuam rhiab heev nrog qhov rhiab heev ntawm 99% thiab qhov kev kwv yees tsis zoo ntawm 99.8% [23].

Txawm li cas los xij, lwm cov kev tshawb fawb soj ntsuam tau qhia tias tus neeg mob ceeb toom nrog kev raug mob ntawm lub ncauj tsev menyuam yuav sim ua kom tus txha nraub qaum thiab qhov muaj qhov cuam tshuam (tsis suav nrog lub thorax) tsis cuam tshuam rau cov txiaj ntsig ntawm kev soj ntsuam ntawm lub ncauj tsev menyuam nqaj qaum thiab yog li ntawd. tus txha caj qaum tuaj yeem raug tshem tawm yam tsis muaj kev tshuaj xyuas ntxiv [24]. Lwm cov kev tshawb fawb qhia cov txiaj ntsig tib yam rau tus txha caj qaum thoracolumbar [25][24].

KEV PAB CUAM UA HAUJ LWM 'Xov tooj cua hauv ntiaj teb? Mus ntsib EMS RADIO BOOTH ntawm Emergency EXPO

Kev mob hnyav

Txawm hais tias ua ntej tsev kho mob txha caj qaum immobilisation tau ua rau ntau xyoo lawm, cov ntaub ntawv tam sim no qhia tias tsis yog txhua tus neeg mob yuav tsum tau immobilised.

Tam sim no National Association of Emergency Physicians USA thiab American College of Surgeons Committee on Trauma qhia txog kev txwv tsis pub siv tus txha caj qaum immobilisation.

Cov txheej txheem tshiab kawg no qhia tau hais tias tus naj npawb ntawm cov neeg mob uas tuaj yeem tau txais txiaj ntsig los ntawm immobilization tsawg heev

Pawg neeg saib xyuas tau hais ntxiv tias kev siv cov kev txwv ntawm tus txha caj qaum thaum thauj yuav tsum tau siv nrog ceev faj, vim qee qhov lawv muaj peev xwm txaus ntshai tshaj lawv cov txiaj ntsig.

Tsis tas li ntawd, nyob rau hauv cov neeg mob uas tau raug kev raug mob nkag mus thiab tsis muaj qhov pom tseeb ntawm lub paj hlwb, tsis pom zoo siv cov kev txwv ntawm tus txha caj qaum.

Hauv Tebchaws Meskas tus neeg teb xov tooj EMS yuav tsum siv kev kho mob ua ntej txiav txim siab siv tus txha caj qaum.[26]

Thaum kawg, tus txha caj qaum immobilisation tau cuam tshuam nrog mob nraub qaum, mob caj dab thiab ua rau nws nyuaj heev rau kev ua qee yam txheej txheem, suav nrog kev tshuaj xyuas.

Spinal immobilisation kuj tau cuam tshuam nrog kev ua pa nyuaj, tshwj xeeb tshaj yog thaum cov hlua loj siv rau hauv siab.

Txawm hais tias ntau lub koom haum EMS hauv Teb Chaws Asmeskas tau txais cov lus qhia tshiab no ntawm tus txha caj qaum immobilisation, qhov no tsis yog universal.

Qee lub tshuab EMS ntshai kev foob yog tias lawv tsis ua rau cov neeg mob tsis tuaj yeem.

Cov neeg mob uas yuav tsum tau immobilized ntawm tus txha caj qaum muaj xws li cov hauv qab no:

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blunt kev poob plig
mob qaum
cov neeg mob uas hloov siab lees txim
neurological tsis txaus
pom tseeb anatomical deformity ntawm tus txha caj qaum
Kev mob hnyav heev hauv tus neeg mob intoxicated los ntawm tshuaj, cawv.

Cov ntaub ntawv pov thawj

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[2] Joyce SM, Moser CS, Kev Ntsuam Xyuas ntawm lub ncauj tsev menyuam tshiab immobilization / extrication ntaus ntawv. Prehospital thiab kev puas tsuaj tshuaj. 1992 Jan-Mar; [PubMed PMID: 10171177]

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[4] Lacey CM, Finkelstein M, Thygeson MV, Qhov cuam tshuam ntawm qhov chaw ntawm kev ntshai thaum txhaj tshuaj: supine piv rau zaum. Phau ntawv Journal of Pediatric Nursing. Lub Rau Hli 2008; [PubMed PMID: 18492548]

[5] Engsberg JR, Standeven JW, Shurtleff TL, Eggars JL, Shafer JS, Naunheim RS, Cervical spine motion thaum extrication. Phau ntawv Journal of Emergency Medicine. 2013 Lub ib hlis ntuj [PubMed PMID: 23079144]

[6] Fischer PE, Perina DG, Delbridge TR, Fallat ME, Salomone JP, Dodd J, Bulger EM, Gestring ML, Spinal Motion Restriction in the Trauma Patient – A Joint Position Statement. Prehospital Emergency Care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. 2018 Nov-Dec [PubMed PMID: 30091939]

[7] Purvis TA, Carlin B, Driscoll P, Qhov tseeb txaus ntshai thiab cov txiaj ntsig tsis txaus ntseeg ntawm kev ywj pheej ua ntej tsev kho mob txha caj qaum immobilisation. American Journal of Emergency Medicine. Lub Rau Hli 2017; [PubMed PMID: 28169039]

[8] Lerner EB, Billittier AJ 4th, Moscati RM, Cov teebmeem ntawm qhov chaw nruab nrab nrog thiab tsis muaj padding ntawm tus txha caj qaum immobilization ntawm cov kev noj qab haus huv. Prehospital Emergency Care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors. 1998 Plaub Hlis Ntuj-Lub Rau Hli; [PubMed PMID: 9709329]

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[10] Haut ER, Kalish BT, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE 3rd, Chang DC, Spine immobilization in penetrating trauma: more harm than good? Phau ntawv Journal of trauma. Lub Ib Hlis 2010; [PubMed PMID: 20065766]

[11] Freauf M, Puckeridge N, TO BOARD LOS YOG TSIS TXAUS SIAB: Ib qho pov thawj REVIEW ntawm PREHOSPITAL SPINAL IMMOBILIZATION. JEMS: ib phau ntawv xov xwm ntawm cov kev pab kho mob xwm txheej ceev. 2015 Nov [PubMed PMID: 26721114]

[12] Kwan I, Bunn F, Cov teebmeem ntawm prehospital spinal immobilization: ib qho kev tshuaj xyuas ntawm cov kev sim randomized rau cov kev noj qab haus huv. Prehospital thiab kev puas tsuaj tshuaj. 2005 Jan-Feb [PubMed PMID: 15748015]

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[14] Nemunaitis G, Roach M. Assistive thev naus laus zis: cov ntawv xov xwm tseem ceeb ntawm RESNA. 2016 Caij nplooj zeeg [PubMed PMID: 26852872]

[15] Kornhall DK, Jørgensen JJ, Brommeland T, Hyldmo PK, Asbjørnsen H, Dolven T, Hansen T, Jeppesen E, Norwegian cov lus qhia rau kev tswj hwm prehospital ntawm cov neeg laus raug mob uas muaj peev xwm raug mob qaum. Scandinavian phau ntawv xov xwm ntawm kev raug mob, resuscitation thiab tshuaj kho mob xwm txheej ceev. 2017 Peb 5 [PubMed PMID: 28057029]

[16] Maschmann C, Jeppesen E, Rubin MA, Barfod C, Cov lus qhia tshiab kho mob ntawm tus txha caj qaum stabilization ntawm cov neeg laus raug mob - kev pom zoo thiab pov thawj raws li. Scandinavian phau ntawv xov xwm ntawm kev raug mob, resuscitation thiab tshuaj kho mob xwm txheej ceev. 2019 Peb 19 [PubMed PMID: 31426850]

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[18] Lub tsev kawm kho mob thiab cov zej zog ib puag ncig: kev sib tham., Zimmerman HM,, Bulletin of the New York Academy of Medicine, 1977 Jun [PubMed PMID: 23417176]

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[20]KOSIAK M, Etiology ntawm decubitus ulcers. Archives ntawm lub cev tshuaj thiab kev kho mob. 1961 Peb [PubMed PMID: 13753341]

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[22]Prasarn ML, Hyldmo PK, Zdziarski LA, Loewy E, Dubose D, Horodyski M, Rechtine GR, Kev sib piv ntawm Lub Nqus Plua Plav piv rau Cov Ncauj Nraum Ib Leeg rau Immobilization ntawm Cervical Spine Injured Patient: A Biomechanical Cadaveric Study. qaum. 2017 Kaum Ob Hlis 15 [PubMed PMID: 28591075]

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