Spinal cord Injury

[Popsickle21]

Okay, so as I was reading in my pediatric nursing book about spinal cord injuries, I started to question what my first priority as a nurse would be if I arrived at the scene on a patient with a suspected spinal cord injury, who wasn't breathing and also required CPR. I've tried to look through my med-surg book for an answer but there wasn't anything with this type of scenario. I've tried to work my way through this, thinking that priority of immobilizing the spine would come first, because any other intervention would cause further damage., but I'm just really not sure. I know ABCs..but does that always apply to this type of case?

[Altra, BSN, RN]

Hint: if you don't get some oxygenation and perfusion going ... is the SCI going to matter?

[wheeliesurfer]

^^^^What they said^^^^

Lets say the patient did have a spinal injury that had not displaced and damaged the cord yet, but has no SOL. What is the worst that will likely happen to them? Unless they are internally decapitated (possible but not highly probable), they will be more likely to live life in a wheelchair than 6 feet under. ABC's trump spinal precaution in my book (not ever likely to be published, so cite with caution ).

[emerjensee]

Have you taken your TNCC course yet? It is worth it's weight in GOLD when moving down the chain of priority assessment and interventions. Fix it as you find it!

Think primary assessment: ABCD..

Your first assessment and interventions would be

verification of a patent airway with simultaneous c-spine protection..

Hope this helps!

-emerjensee

[Christy1019, ASN, RN]

I agree with everything that previous posters have said, but one thing I remember from ENPC is that when you DO go to stabilize c-spine, try to put a rolled up towel or sheet underneath the shoulders to maintain true c-spine alignment. In pediatrics their head is often much bigger in proportion to their body so when they lay on a flat surface the c-spine is not aligned.

But as others have said, if they aren't breathing, paralysis won't matter.

[Esme12, ASN, BSN, RN]

The odds as a nurse to end up on an accident scene that you would have to intervene on is slim. You always keep C-spine precautions in your mind. But a good thing to remember...if they aren't breathing they aren't leaving...well they are leaving...to the morgue.

[h=2]Airway & C-Spine Control[/h] Ensure airway is clear & secure

Chin lift or jaw thrust & maintain

Ensure neck remains in neutral position to control c-spine

Aim to do no further harm

Always assume cervical injury with multi system trauma until proved otherwise

http://www.trauma.org/archive/anaesthesia/initialassess.html

Airway with C spine Control

The airway is the first priority The airway must assessed and maintained while the cervical spine is immobilized. The airway is assessed for obstruction, edema, foreign bodies, etc., which may occlude air from getting to the lungs.

It is important to maintain C- spine alignment and immobilization in the event of C- spine damage to prevent further or possible paralysis or compression of the spinal cord. In the event that the airway is obstructed or occluded, the nurse or individual assessing the airway should use the jaw thrust maneuver without extending the neck to prevent possible damage to the C- spine

Trauma.org | Airway management of the Trauma Victim

[Esme12, ASN, BSN, RN]

thread moved for best response

[emtb2rn, BSN, RN, EMT-B]

It's a trauma code. Jawthrust, keep cspine as neutral as possible & cpr away.