Professional Documents
Culture Documents
Objectives
Anatomy/physiology
Evaluate a patient with spinal injury
Identify common spinal injuries and Xray
features
Appropriately manage the spinal-injured
patient
Determine appropriate disposition
Spinal injury
Sensory Examination
Levels vs sensation
Motor Examination
Table outlining levels
Neurogenic Shock
Hypotension associated with cervical/high
thoracic spine injury
Bradycardia
Tx: fluid, atropine, pressors
Spinal Shock
Classification
Incomplete
Any sensation
Position sense
Voluntary movement in
lower extremity
Sacral sparing
Complete
No motor/sensory
function
No sacral sparing
May have reflexes
Anatomy diagram
Classifications: morphology
Fracture or fracture dislocation
SCIWORA
Penetrating
Classification: morphology
Unstable if:
Xray evidence of injury
Neurologic injury
Severe pain on spine movement or palpation
Xray Guidelines
A
A
B
B
C
C
D
S
C spine Xrays
Cross table lateral detects 85%
Additional 2 views excludes most fractures
May also require:
Swimmers
CT
Flex/ex
MRI
Cspine Xrays
10% have a second fracture
Look for second fracture!
One fracture mandates full spine films
Xray Guidelines
Adequacy
Alignment
Bones
Cartilage
Contours
Disc space
Soft tissue
Thoracolumbar spine
Xray
Paraplegia/quadraplegia
Presumed spinal instability
Identify bony fracture-subluxation
Consult neurosurgery or orthopedics
Clinical
Normal neurologic exam and
Absence of spinal pain/tenderness
Caution!
Drugs, alcohol, distracting injuries
Management
Immobilization
Entire patient
Propper padding
Maintain until cleared
Avoid prolonged use of
backboard
Decubitus ulcer
Medical Management
Ensure A/B
Maintain BP
Atropine prn
Methylprednisolone
Medical Management
Intravenous fluids
Treat hypovolemia first
Consider neurogenic shock
Insert foley
Medical Management
Steroids
Methylpred doses
Medical Management
Transfer
Unstable fractures
Neurologic deficit
Avoid delay
Proper immobilization
Respiratory support as needed
Questions
Summary