incidence of nerve injury in multiple trauma is high. Injury
to the cervical spine and the thoraco-lumbar junction T12–L1
are common. Other common injuries include brachial plexus
injury and nerve damage to legs and fingers.
The first priority is to undertake the primary survey with
evaluation of ABCDE.
maintenance with care and control of a possible injury
to the cervical spine
control or support
control and blood pressure monitoring
the observation of neurological damage and state of consciousness
of the patient to assess skin injuries and peripheral
of spine-injured patients must be carried out with the patient
in the neutral position (i.e. without flexion, extension
or rotation) and without any movement of the spine. The patient
i.e. moved by several people, working together to keep
and spine immobilized
immobilized: in-line immobilization, stiff neck cervical
in a neutral position: i.e. supine.
vertebral injury (which may cause spinal cord injury), look
as well as for a posterior “step-off ” injury
findings indicating injury of the cervical spine include:
in respiration (diaphragmatic breathing – check
and no reflexes (check rectal sphincter)
with bradycardia (without hypovolaemia).
In addition to the initial X-rays, all patients with a suspicion of cervical
spine injury should have an anterior–posterior (AP) and a lateral
X-ray with a view of the atlas-axis joint. All seven cervical vertebrae
must be seen on both views.