Injuries to the spine and spinal cord are frequently associated with other injuries. Initial resuscitation of the patient with multiple injuries from trauma focuses on airway, breathing, and circulation (the ABCs). The patient with a potential spine injury should undergo immobilization to prevent deterioration during resuscitation. Patients who are at risk for spine injury include those who have had automobile and motorcycle accidents, falls, and diving accidents. Any patients complaining of neck pain, weakness, parethesias, or paralysis should be considered to have a spinal cord injury. A patient with a history of trauma and an altered level of consciousness should always be treated as if a spinal cord injury were present.
Spinal immobilization is important to prevent secondary injury. The components of spinal immobilization include a long spine board, a semirigid cervical spine collar, and "sandbags" or other devices to limit head and neck motion. Cervical spine collars alone are ineffective at limiting spine motion. 4 The process for moving a patient onto a spine board or for examination of the back involves a "log-roll." One person is required to maintain the head and neck in neutral position while a minimum of two other people gently roll the patient. The person holding the head directs the team to avoid nonsynchronous motion.
The patient with a spinal cord injury may also present with hypotension due to a loss of sympathetic function and vasodilation below the level of the injury. In a multiply injured patient, other causes of hypotension should be vigorously pursued. Hypotension due purely to a spinal cord injury will be associated with a bradycardia. Hypotension from acute hemorrhage and hypovolemia will be associated with a tachycardia. The initial treatment of hypotension is intravenous fluid. Atropine may be used for significant bradycardia, and vasopressors such as dopamine can be employed if the patient does not respond to fluid boluses.
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