4 Spinal Injuries

Recognizing possible spinal injury

Suspect spinal injury when the mechanism, spinal pain, altered mental status, or neurologic findings raise concern. For example, confusion, neck pain, and tingling in both hands are concerning findings that warrant spinal protection and prompt communication.

Avoid unnecessary spinal movement. Support the head and neck in alignment, maintain spinal precautions, and continue the trauma assessment without delaying urgent care for a suspected injury.

Prioritizing life threats

Address immediate life threats first while protecting the spine and minimizing unnecessary movement. Airway problems take priority over keeping the patient completely still; do not allow spinal precautions to delay lifesaving care.

If a patient with suspected cervical spine injury vomits and has a compromised airway, provide immediate airway care while maintaining manual in-line spinal protection as able. Continue to protect the cervical spine during necessary care.

Moving patients safely

Transfers can move an unstable spine. Use a coordinated transfer with enough trained staff to maintain head, neck, and torso alignment, and plan the movement to minimize bending and twisting. Avoid uncoordinated movement, pulling the patient by the arms, or asking the patient to sit up and pivot.

A longboard is intended for extrication, not routine transport.

Adapting positioning to deformity

Adapt spinal precautions to the patient. If a rigid, pre-existing spinal deformity makes a neutral position uncomfortable, support the patient in the position found, avoid forcing alignment, and alert the trauma team. Forcing a position can worsen pain or neurologic symptoms, and a known deformity may make standard positioning or devices unsuitable.

Monitoring and escalating changes

Reassess carefully while maintaining spinal precautions; suspected injury is not a reason to omit repeat checks. Document spinal pain or tenderness, motor function in the hands and feet, sensation in the hands and feet, and whether neurologic findings are improving or worsening.

Promptly reassess and escalate a new or worsening motor or sensory deficit to the responsible clinician or trauma team. For example, new leg weakness during observation should be communicated promptly; do not wait for the next scheduled check or ask the patient to stand to confirm it. Continue to limit unnecessary movement and follow the emergency team’s plan.

Applying precautions throughout care

Follow local trauma protocols and work within your role. Protect the spine during necessary care, but keep urgent assessment and treatment of life-threatening problems moving forward. Ongoing assessment and prompt communication of new or worsening findings remain important while spinal motion is minimized.

• Spinal motion restriction

• Neutral alignment

• Ongoing neurologic assessment