Wilderness and Rescue Medicine 8th Edition

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Section IV: Trauma

Chapter 15 Review: Spine Injury

• Any traumatic event capable of damaging the spinal column is a positive mechanism for spine injury. • Injury to the spinal column without cord or nerve root injury is the most common. Like other mus- culoskeletal injury, spinal column injury may be stable or unstable. • Unstable column injury increases risk of injury to the spinal cord and nerve roots. Full body stabi- lization and evacuation is the ideal treatment. • The spine assessment criteria are used in cases where a positive or uncertain mechanism of injury exists, but spine injury may or may not have occurred. • A clear spine means no spine injury. This is a calm, cooperative, sober, and alert patient with no new spine pain or tenderness and an intact motor and sensory exam without new symptoms. • A low-risk spine injury presents with tolerable pain and tenderness, the ability to move and bear weight easily, and the ability to self-protect. There is no neurological deficit. • A high-risk spine injury is a positive MOI with altered level of consciousness or severe pain, persis- tent neurologic deficit, and the inability to move or bear weight. • The ideal treatment for high-risk spine injury is whole body stabilization and urgent evacuation. • High-risk spine injury with persistent neurologic deficit is a high-risk problem worthy of an emer- gency evacuation. • Full-body spine stabilization may increase other risks. Ideal protection may be deferred or modified until other risks are minimized. • All patients with an uncleared spine require a follow-up evaluation with an advanced-level practitio- ner, even those you decide to walk out because of a difficult evacuation and an evaluation consistent with a low-risk injury.