Non-disaster/ED triage
Level 1
immediate threat to life
needs to see doctor and nurse immediately
ex: cardiac/respiratory arrest, major trauma, active seizure, shock, status asthmaticus, unresponsive overdose, anaphylaxis, hypoglycemic, SVT, Afib, RVR
Green
will live no matter what
treat these people last
hyperflexion
due to a sudden deceleration of the head and neck
often involves C5-C6
ex: head on MVC, diving accident
simple
usually just a single fracture
vertebrae are aligned and intact
no neurological deficits
central cord syndrome
damage is to the center of the vertebrae
patient will have paralyzed arms but no deficits in legs or bladder
complete spinal cord injuries
how fast does it occur
when does it occur
after the acute phase of injuries at T7 or above
Level 2
emergent threat
needs to see nurse immediately and dr within 15 minutes
ex: decreased LOC, severe resp distress, chest pain, conscious overdose, severe abdominal pain, stroke, GI bleed with abnormal vitals, chemical exposure to eye, suicidal, homicidal
Yellow
may die if not eventually treated
they are breathing and can follow commands
hyperextension
ex: fall, rear end MVC, hit to head, whiplash
common in athletes
can cause contusion and ischemia of spinal cord
compression
usually due to axial loading, but can be due to hyperflexion
brown-sequard syndrome
damage is to one side of the vertebrae
on the side of damage, patient will have altered pain sensation, temp, and touch, as well as motor paralysis below level of injury
on the opposite side of damage, they will have loss of pain, temperature, and touch
incomplete spinal cord injuries
still have some motor and sensory function below the level of injury
biggest symptom/sign
hypotensive and bradycardic due to massive vasodilation
can be precipitated by what
bladder/intestinal distention
spasticity
pressure ulcers
stimulation of skin below the injury
level 3
significant distress
see nurse within 20 minutes and dr within 30
ex: head injury with no LOC change but is vomiting, mild/moderate resp distress, non-active GI bleed, abdominal pain, fever in non-immunocompromised patient
Red
need immediate treatment
unresponsive and cannot follow commands
axial loading/compression
ex: landing on feet after jump/fall, direct blow to head
wedge fracture
stable fracture
involves compression of the vertebral body in the cervical area
anterior cord syndrome
damage is to anterior part of vertebrae
complete motor paralysis below level of injury
patient will have loss of pain, temp, and touch. will still have light touch, proprioception, and position sense
primary spinal injuries
happens at the time of impact
other symptoms
loss of motor, sensory, reflex, and autonomic function below the level of injury with flaccid paralysis
loss of bowel and bladder function
loss of temperature control
can precipitate what
seizure
stroke
Level 4
mild/moderate discomfort
see nurse and doctor within 1 hour
ex: lacerations that need sutures, ankle sprains, urinary discomfort
Black
will die no matter what or are already dead
move them to a designated area
rotational injuries
due to extreme twisting/lateral flexion of head and neck
teardrop fracture
unstable fracture
a piece of bone has broken off the vertebrae
posterior cord syndromes
damage is to posterior of vertebrae
patients will have loss of position sense, light touch, and vibratory sense below the level of injury. still has motor function, pain, and temperature
secondary spinal injuries
hours-days after the initial trauma
phases of spinal shock
phase 1: 0-1 days
phase 2: 1-3 days
phase 3: 1-4 weeks
phase 4: 1-12 weeks
patient symptoms
reflex vasoconstriction below injury
extreme hypertension
bradycardia
throbbing headache
flushing below injury
blurred vision
nasal congestion
Level 5
treatment can be delayed
needs to see doctor and nurse within 2 hours
ex: rash, prescription renewal, follow up rabies shot
Practice triage: 46 y/o male with traumatic amputation of the right leg below the knee, bleeding controlled
yellow
what is the most common mechanism of injury
hyperextension
communitive fracture
vertebrae has shattered into many pieces that may have been driven into the spinal cord
how to quickly fix it
elevate HOB
check catheter for kinks
check for bowel impaction
give sublingual nifedipine for BP
check sheets for objects