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 | Neurological trauma
 


Assessment of the level of injury must be undertaken. If the patient is conscious, ask questions relevant to his or her sensation. Check the motor function of the upper and lower extremities by asking the patient to do minor movements.

The following summarizes key reflex assessment to determine the level of lesion.

MOTOR RESPONSE

:: Diaphragm intact level C3, C4, C5
:: Shrug shoulders Accessory nerve, cranial nerve 11
:: Shoulder abduction C5
:: Biceps (flex elbows) C6
:: Extension of wrist C6
:: Extension of elbow C7
:: Flexion of wrist C7
:: Abduction of fingers C8–T1
:: Active chest expansion Tl–T12
:: Hip flexion L2
:: Knee extension L3–L4
:: Ankle dorsiflexion L5–S1
  Ankle plantarflexion S1–S2


SENSORY RESPONSE
:: Antero-medial thigh L2
:: Anterior knee L3
:: Anterolateral ankle L4
:: Dorsum great and 2nd toe L5
:: Lateral side of foot Sl
:: Posterior calf S2
:: Perianal sensation (perineum) S2–S5 

If no sensory or motor function is exhibited with a complete spinal cord lesion, the chance of recovery is small.

Loss of autonomic function with spinal cord injury may occur rapidly and resolve slowly.



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