Surgical Care at the District Hospital
Part 1 2 3 4 5 6 Primary Trauma Care Manual
ABCDE of trauma
Airway management
Airway management techniques
Ventilation (breathing) management
Circulatory management
Circulatory resuscitation measures
Secondary surgery
Chest trauma
Abdominal trauma
Head trauma
Spinal trauma
Neurological trauma
Limb trauma
Special trauma cases
Transport of critically ill patients
Trauma response
Activation plan for trauma team
Primary Trauma Care Manual | Spinal trauma


The 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.

A Airway maintenance with care and control of a possible injury to the cervical spine
B Breathing control or support
C Circulation control and blood pressure monitoring
D Disability: the observation of neurological damage and state of consciousness
E Exposure of the patient to assess skin injuries and peripheral limb damage.

Examination 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 should be:

:: Log-rolled i.e. moved by several people, working together to keep neck
and spine immobilized
:: Properly immobilized: in-line immobilization, stiff neck cervical collar
or sandbags
;; Transported in a neutral position: i.e. supine.

With vertebral injury (which may cause spinal cord injury), look for:

:: Local tenderness
:: Deformities as well as for a posterior “step-off ” injury
;; Oedema (swelling).

Clinical findings indicating injury of the cervical spine include:

:: Difficulties in respiration (diaphragmatic breathing – check for
paradoxical breathing)
:: Flaccid and no reflexes (check rectal sphincter)
;; Hypotension with bradycardia (without hypovolaemia).

Cervical spine

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.

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