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Spinal Injury (CPG A0804)

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Assessment

  • Major trauma criteria after blunt force trauma to head or trunk

  • Neurological deficit/changes

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Action - Suspected SCI or major trauma

  • Apply cervical collar

  • Extricate and immobilise

  • Tx as per CPG A0105

  • If isolated SCI with BP < 90 mmHg:

    • N/Saline 10 mL/kg IV

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Assessment - TPT

  • If any of the following are present:

    • Age ≥ 65 years

    • Hx of bone or muscle weakening disease/injury

    • Altered conscious state

    • Intoxication

    • Significant distracting injury

    • Midline pain/tenderness

    • Pt unable to rotate neck 45° left and right without pain

  • Mx as per suspected SCI or major trauma

  • Consider self-extrication if Pt is conscious, cooperative, not intoxicated and not prevented by other injuries

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Action - Cervical spine cleared

  • No spinal immobilisation required

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Notes

  • The intent of immobilisation is to support neutral alignment of the spinal column. Techniques employed should be modified if required by circumstances or for Pt comfort/cooperation

  • The Pts head must not be independently restrained to the stretcher

  • The Pt should not be transported on the CombiCarrier

  • Frail/elderly Pts, or those with pre-existing bone disease or spinal abnormalities may sustain unstable injuries with relatively low forces

  • Pts with penetrating trauma do not require routine immobilisation in the absence of neurological deficits

  • In immobilised awake Pts, consider prophylactic anti-emetics as per CPG A0701

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Spinal Injury - Neurological Exam

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Flow Chart

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