5-15. MANDATORY TREATMENT FOR SPINAL INJURY

In some circumstances, it should be assumed that there is spinal injury, regardless of whether or not the patient has signs or symptoms of such an injury. Treating the patient as though he has injury to the spine may spare him further, nonreversible injury.

a. Initial Indications. Initial indications that the patient must be treated as if he has a spinal injury include the following:

(1) The mechanism of injury was violent. Witnesses' statements, the way the accident scene looks, and/or the situation indicate violence.

(2) The patient has a head injury and is in an altered state of consciousness.

(3) The patient is in a state of unconscious trauma.

(4) The patient has significant blunt trauma above the clavicles (collarbones).

(5) Accounts of the accident suggest that a sudden, violent movement, deceleration of the spine, or signs of spinal injury occurred.

(6) The patient was ejected from an automobile.

(7) The patient's helmet was damaged in a motorcycle or sports injury.

(8) The patient is experiencing pain when he moves and when he does not move.

(9) There is point tenderness surrounding the spine. (Point tenderness is tenderness at the site of injury. The patient feels the tenderness when a rescuer presses gently with one finger at the site of the injury.)

(10) There is a deformity in the patient's neck, or the patient guards (protects) his head, neck, or back.

(11) The patient is experiencing paralysis, partial paralysis, numbing, or tingling.

(12) There are signs of vasodilation (widening of the blood vessels allowing increased blood flow).

(13) The patient has a gunshot wound between the neck and the pelvis.

b. Additional Clues. Suspect spinal cord injury if the patient has any of the following:

(1) Extensive abrasions.

(2) Lacerations (wounds made by a tearing of the tissue) to the face/forehead (due to cervical hyperextension).

(3) Scalp lacerations (could be caused by compressions or fracture of the spine)

(4) Abrasions (superficial injury in which skin or mucous membrane is scraped away) of the back of the neck or upper thorax (due to flexion injury to the dorsal spine).

(5) Fractured mandible (jawbone) or associated contusion or abrasion about the jaw (associated with rotational injury to the spine).

(6) Calcaneal injury (heel bone), thoracic, and lumbar compression fracture.

(7) Abdominal bruises (lumbar fracture).