C-spine - Initial Management and Immobilisation

A few basic points to remember
Spinal immobilisation is not without consequence
PEARL

A few basic points to remember : 

• Assume that all blunt trauma patients have spinal cord injury until proven otherwise. The spine must be adequately protected until injury has been identified or the spine has been clinically cleared by a clinician. 
• In most patients with spinal injury, the neurological deficit is clinically apparent early in the course of evaluation. 
• However, mechanically unstable spines are especially vulnerable to additional injury from external forces. Excessive manipulation may cause or worsen spinal cord injury. Attention to detail, careful protection of the spine, and frequent examinations will decrease this risk. 
• Many studies have examined techniques for optimal cervical immobilisation using a variety of cervical collars, backboards, and extrication devices. 
• These efforts have resulted in the universal practice of spinal immobilisation with a rigid cervical collar (which incorporates the upper thorax), sandbags or taped blocks, and a long spine board (padded or unpadded). 
• The rationale for this intervention dates back to the report by Rogers in 1957 that showed that 10% of spinal cord injuries occurred or were exacerbated following the initiation of professional medical care. 

Spinal immobilisation is not without consequence. 

1. The patient with inadequate protective reflexes can easily aspirate while strapped in the supine position. 
2. Others with minor brain injury or intoxication may become combative when tied to the board. Pharmacologic control of the patient may be required until spinal injury can be reliably demonstrated or excluded. 
3. In addition, prolonged immobilisation may cause significant discomfort and pressure necrosis. 

For these reasons, the patient should be removed from the spine board as soon as possible. 

In the patient with a clear-cut spinal cord injury, prompt removal from the spine board is even more critical—not less. Impaired sensation and sympathetic tone put these patients at increased risk for pressure sores, rhabdomyolysis, and compartment syndrome. 

PEARL 

Clearing the C-spine and logrolling the patient off the trauma board onto a firm mattress are two separate issues!