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.
|
