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Key Questions
When do I suspect spine injury?
How do I confirm the presence or
absence of a significant spine injury?
How do I protect the spine during
evaluation and transport?
How do I assess the patients neurologic
status?
Unconscious patient
Neurologic deficit
Spine pain / tenderness
C-spine X-rays
Crosstable lateral film excludes 85% of
fractures
Addition of AP and odontoid views
exclude most fractures
Also may require
Swimmers view
MRI
CT scan for bony detail
C-spine X-rays
10% of patients with a c-spine fracture
have a 2nd, associated noncontiguous
vertebral column fracture
Identify 1 abnormality? Look for
another!
Radiographic screening of entire spine
required in this situation
At least 5% of patients
With spinal cord injuries
Worsen neurologically at
hospital.
Management
Provide respiratory support as needed
Properly immobilize entire patient
Avoid transfer delay!
Who do I transfer?
Unstable fractures
Neurologic deficit
Avoid transfer delay!