Spinal Injury (Paed) CPG Notes Flashcards
(19 cards)
What are the main objectives when managing a suspected spinal cord injury (SCI) in paediatrics?
Identify suspected SCI and transfer the patient to the appropriate facility, protect spinal integrity, and avoid unnecessary immobilisation by excluding injury where safe.
These objectives ensure proper care and minimize further injury.
Who does this guideline apply to?
Patients under 16 years of age with a mechanism of injury (MOI) capable of causing spinal injury.
This includes both traumatic and non-traumatic incidents.
What MOIs are considered concerning for spinal injury?
Those involving hyper-flexion, extension, rotation, or axial loading.
These mechanisms can significantly stress the spine.
Why are spinal injuries in healthy children rare?
A large amount of force is required to damage healthy paediatric vertebrae.
This is due to the strength and flexibility of children’s bones.
Which conditions increase the risk of spinal injury with less force?
- Vertebral disease (e.g. ankylosing spondylitis)
- Previous spinal surgery
- Down syndrome
- Osteogenesis imperfecta
- Achondroplasia
These conditions compromise spinal integrity.
When should immobilisation not be routinely applied?
In cases of penetrating trauma unless there’s a neurological deficit.
This approach minimizes unnecessary immobilisation.
How are neurological deficits handled in this guideline?
They indicate actual SCI and trigger a separate, urgent care pathway.
Immediate assessment and intervention are critical.
Can spinal clearance be attempted in patients with major trauma or neurological deficits?
No. These patients should be managed as time-critical and spinal clearance should not be attempted.
This is crucial to avoid further complications.
What are the 5 key criteria to spinally clear a child?
- No neurological deficit
- No vertebral pain/tenderness
- No factors making assessment unreliable (e.g. altered consciousness, distracting injury)
- No increased risk (e.g. Down syndrome)
- Normal neck range of motion (~45° L/R)
These criteria help ensure safe assessment.
What factors make a physical exam unreliable?
GCS <15, intoxication, distracting injuries, developmental delay.
These factors can impair accurate assessment.
What is the intent of spinal immobilisation?
To support the spine’s neutral alignment and reduce forces on it.
Proper immobilisation is essential to prevent further injury.
When might a collar be loosened or removed?
If it’s ineffective or causes agitation, and no alternatives are available.
Patient comfort and safety are priorities.
When should patients be supported in a position of comfort rather than immobilised?
Children who hold their head, have torticollis, or abnormal neurology.
This approach tailors care to individual needs.
When is the CombiCarrier extrication board used?
Only for extrication, not for transport.
This ensures proper handling during emergency situations.
What stabilisation method is used during transfers/intubation?
Manual In-Line Stabilisation (MILS).
This technique helps maintain spinal alignment.
Why is thoracic elevation recommended in patients <8 years old?
Their large occiput can cause neck flexion when supine.
Proper positioning is essential for spinal safety.
How much elevation is generally sufficient?
2–4 cm using folded towels.
This minimal elevation helps prevent neck flexion.
What monitoring is required for suspected SCI?
- Vital signs & neuro obs: every 15 min
- Continuous cardiac monitoring
- Continuous SpO₂
- Continuous nasal capnography if appropriate
Regular monitoring helps detect any deterioration.
What does a rising ETCO₂ indicate?
Hypoventilation — patient may need ventilation/escalation of care.
This is a critical sign in monitoring respiratory status.
