Spinal cord injury

Question 1

treatment

Answer 1

• Assess for the presence of other major injuries.
• Ensure the patient is appropriately immobilised, positioned, protected from pressure injury and kept warm.
• Gain IV access.
• Administer 0.9% sodium chloride IV if there are signs of hypovolaemia or poor perfusion, or the systolic blood pressure is less than 120 mmHg in an adult, or less than the normal predicted systolic blood pressure in a child:
  a) 1 litre for an adult.
  b) 20 ml/kg for a child.
  c) Administer one further bolus if required.
• Administer metaraminol IV in addition to 0.9% sodium chloride, if the systolic blood pressure is less than 120 mmHg in an adult, or less than the normal predicted systolic blood pressure in a child.

Question 2

If all the following criteria are met, the patient’s cervical spine can be cleared clinically:

Answer 2

a) A normal level of alertness, and
b) No tenderness at the posterior midline of the cervical spine, and
c) No signs or symptoms of spinal cord injury, and
d) No pain or other factors that might distract the patient from the pain of a
cervical spine injury.

Question 3

If the patient’s cervical spine cannot be cleared clinically:

Answer 3

a) Place a firm cervical collar if the patient has:
ū Significant posterior midline tenderness, or
ū Signs or symptoms of spinal cord injury.
b) Place a lanyard around the patient’s neck if a firm cervical collar has not been placed and consider using head blocks, rolled towels or manual stabilisation of the neck.

Question 4

Clearing the cervical spine clinically steps

Answer 4

Begin by taking a history, does the patient have:
ū Neck pain?
ū Numbness or tingling anywhere?
ū Pain elsewhere?
* Examine the patient:
ū Feel for midline tenderness by palpating the posterior cervical spine from the skull to the prominence of the first thoracic vertebrae. Lateral muscle tenderness is not a sign of cervical spine injury.ū Assess for normal sensation to light touch in the limbs.
ū Assess for normal movement of the limbs.
ū Assess for signs of decreased alertness.
ū A GCS less than 15.
ū Short term memory loss.
ū Clinical signs of intoxication.
ū Delayed or inappropriate response to external stimuli.

Question 5

The following factors increase the risk of cervical spine injury:

Answer 5

ū Road crash involving rollover or ejection.
ū Fall from a significant height. For example, more than one metre or more
than five stairs in an adult, particularly if head first.
ū Diving head first into shallow water.
ū Injury involving axial loading of the spine. For example, a rugby scrum
collapse.
ū Pre-existing cervical spine abnormalities. For example, rheumatoid arthritis
and ankylosing spondylitis.