Spinal Injury (Adult) CPG Notes

Question 1

What are the care objectives when managing suspected spinal cord injury (SCI)?

Answer 1

Identify patients with suspected SCI and transfer them to the appropriate facility. Protect the spinal column where SCI or unstable vertebral injury cannot be excluded. Avoid unnecessary immobilisation when spinal injury is ruled out.

Question 2

Who does this guideline apply to?

Answer 2

Patients aged ≥ 16 years with a mechanism of injury (MOI) capable of causing spinal injury.

Question 3

What’s the difference between spinal cord injury and unstable vertebral injury?

Answer 3

Spinal cord injury: Direct injury to the cord with neurological deficits. Unstable vertebral injury: Vertebral injury that may support or threaten the spinal cord; often without neuro signs but may present with pain.

Question 4

What mechanisms are considered concerning for SCI?

Answer 4

• Hyper-flexion
• Hyper-extension
• Hyper-rotation
• Axial loading
• Car rollovers
• Diving
• Pedestrian impact
• Falls from height

Question 5

Who is at higher risk for SCI with less force?

Answer 5

• Patients ≥ 65 years
• Patients with vertebral disease or previous spinal injury/surgery

Question 6

Should patients with penetrating trauma be immobilised?

Answer 6

Only if they have a neurological deficit.

Question 7

List the criteria for spinal clearance.

Answer 7

• No neurological deficit
• No vertebral pain/tenderness
• No distracting injuries, intoxication, or altered LOC
• No increased risk of injury (e.g., ankylosing spondylitis)
• Normal range of neck motion

Question 8

What is the purpose of spinal immobilisation?

Answer 8

To support natural spinal alignment and reduce/distribute forces.

Question 9

What are key considerations for proper spinal immobilisation?

Answer 9

• Don’t restrain the head to the stretcher
• Position with ~15° elevation where possible
• Avoid immobilising patients to the CombiCarrier for transport
• Adjust collar if needed for comfort or airway

Question 10

How do you assess motor function for SCI?

Answer 10

• Arms: Grasp/push/pull
• Legs: Push/pull/plantarflex/dorsiflex/leg raise

Question 11

How do you assess sensory function for SCI?

Answer 11

• Arms: Light touch to palm/back of hand (C6–8)
• Legs: Light touch to side of heel (S1)

Question 12

How is neck ROM tested safely?

Answer 12

Ask the patient to slowly turn their own head ~45° each way. Stop if they feel pain. Never turn it for them.

Question 13

How do you manage isolated spinal cord injury?

Answer 13

• Nasal capnography
• Normal Saline 500 mL IV if BP < 120 mmHg
• Atropine if bradycardia + hypotension
• Metaraminol/Noradrenaline if inadequate fluid/atropine response

Question 14

How should patients with suspected SCI be monitored?

Answer 14

• 15 min vitals and neuro obs
• Continuous cardiac monitoring, SpO₂, nasal capnography

Question 15

What does elevated nasal ETCO₂ indicate?

Answer 15

Hypoventilation – consider escalation.