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Trauma
General Management
IMMOBLIZATION
Suspected spine injury should be immobilized above
and below the suspected injury site until a fracture is
excluded by x-ray examination. Spinal protection should
be maintained until a cervical spine injury is excluded.
Proper immobilization is achieved with the patient in the
neutral positionthat is, supine without rotating or
bending the spinal column.
General Management
Immobilization of the neck with a semirigid collar does not
ensure complete stabilization of the cervical spine.
Immobilization using a spine board with appropriate bolstering
devices is more effective in limiting certain neck motions. The
use of long spine boards is recommended.
Cervical spine injury requires continuous immobilization of the
entire patient with a semirigid cervical collar, head
immobilization, backboard, tape, and straps before and during
transfer to a definitive-care facility.
General Management
The airway is of critical importance in patients with
spinal cord injury, and early intubation should be
accomplished if there is evidence of respiratory
compromise.
During intubation, the neck must be maintained in a
neutral position and If necessary, a sedative or paralytic
agent (short-acting, reversible) may be administered,
while ensuring adequate airway protection, control, and
ventilation.
General Management
Removal of the board is often done as part of the secondary
survey when the patient is logrolled for inspection and
palpation of the back.
The safe movement, or logrolling, of a patient with an unstable
or potentially unstable spine requires planning and the
assistance of four or more individuals, depending on the size of
the patient.
Neutral anatomic alignment of the entire vertebral column must
be maintained while rolling and lifting the patient.
General Management
General Management
INTRAVENOUS FLUIDS
In patients in whom spine injury is suspected,
intravenous fluids are administered as they would
usually be for resuscitation of trauma patients.
If active hemorrhage is not detected or suspected,
persistent hypotension should raise the suspicion of
neurogenic shock. Patients with hypovolemic shock
usually have tachycardia, whereas those with
neurogenic shock classically have bradycardia.
General Management
If the blood pressure does not improve after a fluid
challenge, the judicious use of vasopressors may be
indicated.
Phenylephrine hydrochloride, dopamine, or norepinephrine
is recommended. Overzealous fluid administration may
cause pulmonary edema in patients with neurogenic shock.
A urinary catheter is inserted to monitor urinary output
and prevent bladder distention.