7.3 Spinal Immobilisation I QAS Spinal Cord Injury

Spinal cord injury (SCI)

Injury to the spine or spinal cord with motor, sensory, and/or autonomic deficit.

Common mechanisms of SCI

Hyperflexion, hyperextension, rotation, compression, penetrating trauma.

Leading causes of SCI

Road traffic crashes, falls, assaults, sports injuries, recreational water accidents.

Motor deficits in SCI

Diaphragmatic ventilation, paralysis, flaccidity, abnormal posturing.

Sensory deficits in SCI

Local/generalised paresthesia, loss of proprioception.

Autonomic dysfunction in SCI

Hypotension, bradycardia, thermodysregulation, priapism.

Diagnostic pattern for SCI

Mechanism of injury, vertebral pain/tenderness, impaired motor/sensory function, impaired autonomic function.

Principles of prehospital SCI management

Limit neurological deficit, prevent secondary injury via spinal motion restriction, life-threat reversal, cardiovascular & ventilatory support, thermoregulation.

Neurogenic shock in SCI

Loss of sympathetic outflow (injury above T5 or CNS injury) → vasodilation, hypotension, bradycardia.

Response of neurogenic shock patients to fluids

Poorly, due to vasodilation not hypovolaemia.

Spinal shock

A transient state post-cord injury with flaccid paralysis, areflexia, anaesthesia below lesion; usually resolves in months as reflexes return.

Autonomic dysreflexia in SCI

Does not occur in the acute phase.

Management of immersion patients without GCS 15

Considered potential SCI until proven otherwise.

Caution in applying NEXUS criteria

In extreme age groups (very young/elderly).

Clinical judgement and NEXUS clearance

Yes, immobilisation may be needed even if criteria suggest low probability of injury.

High-risk conditions alongside SCI

Shock, haemorrhage, traumatic brain injury.

Use of extrication boards

They are designed for extrication, not long-term spinal restraint.

Inappropriate use of KED/NEIJ devices

In rapid extrication for life-threatening injuries or unstable vitals; use MILS instead.

NEXUS criteria for radiography

If any of the following are present: Midline cervical tenderness, Evidence of intoxication, Altered level of alertness, Focal neurological deficit, Painful distracting injury.

Posterior midline tenderness in NEXUS

Pain with palpation of posterior cervical spine from nuchal ridge to T1, or tenderness of spinous processes.

Definition of intoxication under NEXUS

History of ingestion, odour of alcohol, slurred speech, ataxia, abnormal behaviour, or positive drug/alcohol screen.

Altered level of alertness in NEXUS

GCS ≤14, disorientation, memory failure, delayed/inappropriate responses, or abnormal mental status.

Painful distracting injury

Any injury severe enough to mask neck pain (e.g., long-bone fracture, visceral injury, degloving injury, large burns).

Validation of NEXUS in paediatrics

Yes, but children may still develop SCI without radiological abnormality (SCIWORA).

Destination of choice for SCI patients

A designated spinal centre, with air transport considered if appropriate.

Management considerations for neurogenic shock in SCI

FAST scan, IV fluids, inotropes, analgesia, antiemetics.

General treatments for SCI patients

Analgesia, antiemetics, IV fluids if indicated, monitoring for associated injuries.

Assessment of intoxicated patients for SCI

With additional caution, as intoxication may mask symptoms of spinal injury.