1. Spine Injury LAMRT Nov 08

2. Spinal cord injuries ● All patients with multiple trauma should be suspected of having a spinal injury ● Failure to detect usually results from failure to suspect ● Cervical spine and thoraco-lumbar junction are the commonest site of injury ● The percentage of nerve injuries seen in patients with spinal fractures are: Cervical spine 40% Thoracic spine 10% Thoraco-lumbar junction 35% Lumbar spine 3% ● All injuries should be assumed to be unstable until proven otherwise

3. Management ● Maintain in-line spinal immobilisation ● Support manually then with a stiff collar and blocks or vac mat ● Patient should be transported on vac mat or spinal board Primary Survey ● Airway protection required whilst maintaining in-line immobilisation (High flow oxygen) ● Pharyngeal stimulation with airway can caused vagal discharge and cardiac arrest ● Cervical spine injuries reduce sympathetic outflow and pulse rate ● Patients may have both low BP and bradycardia – NB - Not a feature of hypovolaemia therefore suspect spinal cord injury Aggressive fluid resuscitation can induce pulmonary oedema