In Er, health care providers are confronted to spine injury, where wrong manipulations and positions, may provoke irreversible impacts. Here are some hints to meet the challenge

1. 14 - September - 2012 Prepared By Dr Gamal Soliman 1
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
SPINAL CORD INJURY

2. 14 - September - 2012 Prepared By Dr Gamal Soliman 2
S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
DEFINITIONDEFINITION
Spina cord injury (SCI) is aSpina cord injury (SCI) is a traumatictraumatic injury toinjury to
the spinal cord that may vary from a mild cordthe spinal cord that may vary from a mild cord
concussion with transient numbness to immediateconcussion with transient numbness to immediate
and complete tetraplagia. The most common sitesand complete tetraplagia. The most common sites
are theare the cervicalcervical areas C5, C6 and C7 and junctionareas C5, C6 and C7 and junction
of the thoracic andof the thoracic and lumbarlumbar vertebrae, T12, L1.vertebrae, T12, L1.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
OBJECTIVEOBJECTIVE
1.1. To prevent further trauma.To prevent further trauma.
2.2. To observe symptoms ofTo observe symptoms of
progressive neurologic deficits.progressive neurologic deficits.
3.3. To improve breathing pattern andTo improve breathing pattern and
airway clearance.airway clearance.
4.4. To improve mobilityTo improve mobility

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5.5. To improve sensory andTo improve sensory and
perceptual awarenessperceptual awareness
6.6. To relieve urinary retention.To relieve urinary retention.
7.7. Improve bowel function.Improve bowel function.
8.8. Absence of complicationsAbsence of complications
9.9. Promote comfort.Promote comfort.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
POLICY
1. Assessment of patient with
spinal cord injury include:
Patent airway
Location and severity of cord
damage
Neurologic level of injury
Vital signs

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
2. Injuries to the spinal
column include:
Fracture with and without
bone displacement
Dislocations
Ligament sprains
Disk injury, including
compression

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3.3. Any unconscious patientAny unconscious patient
who is the victim of accidentwho is the victim of accident
must be assessed to have spinal injury.must be assessed to have spinal injury.
4.4. All unconscious trauma patientsAll unconscious trauma patients
and all patients with possible spinal injuriesand all patients with possible spinal injuries
should be rigidly immobilized.should be rigidly immobilized.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5.5. Signs and symptomsSigns and symptoms
include:include:
Pain without movementPain without movement
Pain with movementPain with movement
TendernessTenderness
DeformityDeformity
Impaired breathingImpaired breathing
PriapismPriapism
Characteristic positioningCharacteristic positioning
of the arm.of the arm.
Involuntary loss of bowelInvoluntary loss of bowel
and bladder control.and bladder control.
Nerve impairment to theNerve impairment to the
extremitiesextremities
5.10 Nerve shock5.10 Nerve shock

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
MATERIALS &MATERIALS &
EQUIPMENTEQUIPMENT
1.1. Spinal bedSpinal bed
2.2. Cervical collarCervical collar
3.3. Sand bagsSand bags
4.4. OxygenOxygen
equipmentequipment

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5.5. SuctionSuction
machinemachine
6.6. CardiacCardiac
monitormonitor
7.7. PulsePulse
oximetryoximetry
8.8.
NasogastricNasogastric
tube.tube.
9.9. UrinaryUrinary
catheter.catheter.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
1. Obtain history of the accident:1. Obtain history of the accident: 1. To1. To
determine data baseline.determine data baseline.
1.11.1 Neck and back painNeck and back pain
1.21.2 NumbnessNumbness
1.31.3 TinglingTingling
1.41.4 Sensation in extremitiesSensation in extremities

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
2. Assess the2. Assess the
following:following:
2.12.1 CardiopulmonaryCardiopulmonary
statusstatus
2.22.2 Loss ofLoss of
consciousnessconsciousness
2.32.3 Note signs andNote signs and
symptoms of spinalsymptoms of spinal
shock such as:shock such as:
flaccid, paralysis,flaccid, paralysis,
urinary retention,urinary retention,
absent reflexesabsent reflexes

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
2.42.4 Bowel and bladderBowel and bladder
function.function.
2.52.5 Quality, location,Quality, location,
severity of pain.severity of pain.
2.62.6 Depression,Depression,
powerlessness,powerlessness,
dependence,dependence,
passivitypassivity
2.72.7 Changes in motorChanges in motor
and sensoryand sensory
functionfunction 2. Data2. Data
baseline to determinebaseline to determine
degree of autonomicdegree of autonomic
dysfunction.dysfunction.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3. Maintain patent3. Maintain patent
airway, be prepared toairway, be prepared to
intubate ifintubate if
respiratory arrest occurs.respiratory arrest occurs.
4. Administer oxygen4. Administer oxygen
as orderedas ordered
4.1 Monitor4.1 Monitor
saturation through pulsesaturation through pulse
Oximetry.Oximetry.
5. Immobilize the head5. Immobilize the head
and neck:and neck:

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3. Maintain patent3. Maintain patent
airway, be prepared toairway, be prepared to
intubate ifintubate if
respiratory arrest occurs.respiratory arrest occurs.
4. Administer oxygen4. Administer oxygen
as orderedas ordered
4.1 Monitor4.1 Monitor
saturation through pulsesaturation through pulse
oximetry.oximetry.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
3. Maintain patent3. Maintain patent
airway, be prepared toairway, be prepared to
intubate ifintubate if
respiratory arrest occurs.respiratory arrest occurs.
4. Administer oxygen4. Administer oxygen
as orderedas ordered
4.1 Monitor4.1 Monitor
saturation through pulsesaturation through pulse
oximetry.oximetry.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
5.25.2 Apply cervical collarApply cervical collar
5.35.3 Provide sand bagsProvide sand bags

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
6. Check and6. Check and
monitor vital signsmonitor vital signs
6. Patient6. Patient
with SCI can bewith SCI can be
hypotensive duehypotensive due
to theto the
effect of injury oneffect of injury on
the Sympatheticthe Sympathetic
nervous system.nervous system.

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
6.6. Provide I.V. access for:Provide I.V. access for:
7.17.1 I.V. fluidsI.V. fluids
7.27.2 I.V. medications asI.V. medications as
orderedordered
7.37.3 Blood extraction.Blood extraction. 7. To7. To
facilitate immediatefacilitate immediate
administration ofadministration of
emergencyemergency
drugs as ordereddrugs as ordered

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
8. Place patient on8. Place patient on
firm bed until spinalfirm bed until spinal
cord stabilization.cord stabilization.
8. To ensure good8. To ensure good
alignment.alignment.
9. Insert nasogastric9. Insert nasogastric
tube as paralytictube as paralytic

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
10. Measure10. Measure
intake and output.intake and output.
10.110.1
IntermittentIntermittent
catheterizationcatheterization

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A
10.2 Encourage fluid intake.10.2 Encourage fluid intake. 10.210.2
To prevent infection andTo prevent infection and
urinary calculi.urinary calculi.
11. Expedite admission to ICU11. Expedite admission to ICU

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A

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S ilv e r C r e s c e n t D is p e n s a r y – K h o b a r - K S A