1. INITIAL ASSESSMENT AND CARE IN SPINAL TRAUMA PATIENT DR. Seyed Mani Mahdavi Orthopedic Spine Surgeon

2. Advanced Trauma Life Support

3. As a general rule, all trauma patients need to be fully investigated for spinal injury Even mild complaints of pain or posterior midline tenderness

4. Field Care The head and neck need to be aligned with the long axis of the trunk and immobilized in this position

5. Kendrick Extrication Device for Spinal Immobilization

6. Immobilization with cervical collar, sandbags, tape, and spine board is superior to immobilization with a collar alone

7. field transportation log-rolling technique

8. Neutral flexion-extension head and neck alignment is optimal during pre hospital transport of cervical spine injury patient

10. helmet and shoulder gear safe removal techniques

11. Preliminary assessment of neurologic status in the field extremely valuable asking about neck pain, back pain, numbness, and weakness

12. When a spinal cord injury is suspected, steroids should be started in the field

13. Emergency Room Care Assessment of gross neurologic function Diagnosis of severely unstable injuries Assessment of hemodynamic parameters (neurogenic shock) spinal shock should be distinguished from neurogenic shock(Spinal shock refers to depressed spinal reflexes caudal to spinal cord injury)

16. IMAGING AND DIAGNOSTIC STUDIES Clearing the spine frequently requires considerable time, with one study reporting a median time of 15 hours

17. Most spine injuries occur at the junctions: craniocervical,cervicothoracic, and thoracolumbar. They are often the most difficult to see on standard radiographs.

18. Emergent life-saving interventions, such as intubation, anesthesia, and abdominal or chest surgery, can be performed relatively safely using appropriate precautions in a patient with incompletely evaluated cervical spine.

19. AP chest radiograph,AP pelvis radiograph, and a lateral cervical spine radiograph

21. The End