Cervical Spine Injuries

Kinna P. Siarro, RN

 Injuries to the cervical spine are serious because the crushing, stretching, and rotational shear forces exerted on the cord at the time of trauma can produce severe neurologic deficits Edema and cord swelling contribute further to the loss of spinal cord function.

PRIMARY ASSESSMENT

 Any person with a head, neck, or back injury or fractures to the upper leg bones or to the pelvis should be suspected of having a potential spinal cord injury until proved otherwise

 Provide immediate immobilization of the spine while performing assessment. Airway.

Breathing.
Intercostal paralysis with diaphragmatic breathing indicates cervical spinal cord injury.

 In conscious patient, observe for increased respiratory rate and difficulty in speaking due to shortness of breath. Circulation. Disabilityassess neurologic status.

PRIMARY INTERVENTIONS

 Immobilize the cervical spine. Open the airway using the jaw-thrust technique without head tilt. If the patient needs to be intubated, it may be done nasally.

 If respirations are shallow, assist with a bag-valve mask.

Administer high-flow oxygen to minimize potential hypoxic spinal cord damage.

SUBSEQUENT ASSESSMENT

 Assess the position of the patient when found; this may indicate the type of injury incurred. Hypotension and bradycardia accompanied by warm, dry skin suggests spinal shock. Neck and back pain/extremity pain or burning sensation to the skin. History of unconsciousness.

 Total sensory loss and motor paralysis below level of injury.

Loss of bowel and bladder control; usually urinary retention and bladder distention.
Loss of sweating and vasomotor tone below level of cord lesion. Priapismpersistent erection of penis.

 Hypothermiadue to the inability to constrict peripheral blood vessels and conserve body heat. Loss of rectal tone.

GENERAL INTERVENTIONS

NURSING ALERT A spinal cord injury can be made worse during the acute phase of injury, resulting in permanent neurologic damage.

Proper handling is an immediate priority.

 Insert an NG tube. Keep the patient warm. Initiate I.V. access. Insert an indwelling urinary catheter to avoid bladder distention. Monitor for hypotension, hypothermia, and bradycardia. Continue with repeated neurologic examinations to determine if there is deterioration of the spinal cord injury.

 Be prepared to manage seizures. Pharmacologic interventions: high-dose steroids (methylprednisolone). The standard regimen is 30 mg/kg I.V. loading dose over 15 minutes, followed by a 5.4 mg/kg/hour infusion to be initiated 45 minutes later. Continue the infusion for 23 hours.