EXECUTIVE SUMMARY

Follow recent guidelines for acute Cervical spine and spinal cord injuries to prevent further injury in these patients.

* The complete spine should be immobilized until injury has been ruled out.

* Perform a careful initial respiratory assessment, monitor closely for ventilatory compromise, and perform frequent serial neurological checks.

* Methylprednisolone is used to decrease the Secondary Injury to the spinal cord.

If you don't follow recent guidelines, a patient may come into your ED with a spinal cord injury and leave paralyzed.

"Patients with cervical spine fractures could cause more damage to their spinal cord if not appropriately immobilized," underscores Kelli Vaughn, RN, BSN, CEN, trauma nurse coordinator at John D. Archbold Memorial Hospital in Thomasville, GA. "This could lead to more paralysis and greater complications."

New guidelines for acute cervical spine and spinal cord injuries were developed by the Rolling Meadows, IL-based American Association of Neurological Surgeons and the Schaumburg, IL-based Congress of Neurological Surgeons.

Use these key points from the guidelines to ensure you don't injure a patient with potential spinal cord injuries:

* Make sure the patient is immobilized adequately.

Since approximately 20% of spinal cord injuries involve noncontinuous vertebral levels, the complete spine should be immobilized until injury has been ruled out, advises Michael Frakes, BSN, CFRN, CCRN, EMTP, flight nurse at Lifestar/Hartford (CT) Hospital. Adequate immobilization consists of a rigid cervical collar with supportive blocks on a rigid backboard with straps, he says.

You must make sure that adequate precautions are taken for all patients who present with a possible spinal cord injury, stresses Frakes. "This includes ensuring the adequacy of spinal restriction placed by EMS [emergency medical services] and also placing appropriate equipment on patients who do not arrive by EMS," he says.

According to the Des Plaines, IL-based Emergency Nurses Association's Trauma Nurse Core Course, spinal immobilization is required for "any patient whose mechanism of injury, symptoms, or physical findings suggest a spinal injury," notes Frakes.

The following areas are associated with potential spinal injury, he says:

--Mechanism of injury: Motor vehicle crash, fall, diving injury, near-drowning, direct force to spine or head, penetrating trauma to spine, or ejection from motor vehicle.

--Symptoms: Spinal pain or tenderness, paresthesias, and paralysis.

--Physical findings: Head injury or altered level of consciousness after trauma.

* Don't remove immobilization until adequate imaging is completed.

No single film can adequately rule out injury in symptomatic or obtunded patients, says Frakes. These patients should have a three-view series of plain films supplemented by computerized tomography or magnetic resonance imaging, he explains.

"You should ensure that immobilization remains in place until adequate imaging is completed and the studies read," says Frakes.