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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
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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.
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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

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