SPINAL INJURY

Standard ABCDE's Immobilize patient Careful, thorough spinal examination

- Focal tenderness
- Deformities, such as "step-off injury"
- Swelling
- Difficulty in breathing—diaphragmatic, accessory muscles
- Flaccid muscles with areflexia
- Neurogenic shock: hypotension with bradycardia due to loss of sympathetic tone

NEUROLOGICAL EXAMINATION

Sensation

- Test pinprick sensation in extremities and trunk
- Test perianal sensation to evaluate sacral roots

Motor Function

- Evaluate motion, strength of major muscle groups
- Evaluate rectal sphincter tone

Reflexes

- Deep tendon reflexes in upper, lower extremities
- Anal wink: scratch skin next to anus—anus contracts in positive test
- Babinski reflex: stroke bottom of foot—toes flex normally and extend with upper motor nerve injury

MOTOR EXAMINATION

- Diaphragm intact		C3-5
- Shrug shoulders		C11
- Deltoid		C5
- Biceps		C6
- Triceps		C7
- Finger abduction		C8-T1
- Hip flexion		L2
- Knee extension		L3-4
- Ankle dorsi flexion		L5-S1
- Ankle plantar flexion		S1-2

SENSORY EXAMINATION

Deltoid   C5 Dorsum hand   C6-8 Nipple   T4 Navel   T10 Ant. Knee   L3 Lateral foot   S1

SPINAL INJURIES

• Evaluate spine based on
  - History of injury
  - Physical examination
  - Complete neurological examination
  - X-rays, if available
• Spinal column injuries are stable or unstable, based on bone, ligament damage
• Neurological function may be normal, show incomplete injury or complete spinal cord disruption
• Base your treatment on extent of injury
• Ask the patient regarding spine pain and midline tenderness
• Ask regarding strange feelings or loss of feeling in an extremity
• Assume that an unconscious patient has a spine injury
• The patient must be maintained in neutral position
  - No flexion, extension, rotation
• Log roll the patient
  - Look for bruising, swelling
  - Look for displacement of spinous processes
• Perform a complete neurological assessment

X-ray examination

• Entire spine in unconscious patients
• Symptomatic areas of cervical, thoracic and lumbar spines in conscious patients
• Cervical spine in all patients in high-energy multiple trauma
  - Lateral and AP-films
  - All seven cervical vertebrae
  - Open mouth odontoid view

Entire spine immobilized in neutral position, regardless of neurological status Log roll for examination Must have IV hydration; spinal shock may be delayed Patients with spine fractures or spinal cord injury should be referred.

X-ray of C2 and C6 fractures

LOG ROLLING

Moving any patient before spine is cleared requires very careful turning: maintain entire spine in neutral position, particularly cervical spine