The primary assessment of a patient with trauma in the field follows the ABCD prioritization scheme:
- Disability (neurologic status). If the patient has a head injury, is unconscious or confused, or complains of spinal pain, weakness, and/or loss of sensation, then a traumatic spinal injury should be assumed. Extreme care should be taken to allow as little movement of the spine as possible to prevent more cord injury.
Injuries that are being assessed while in the field follow the ABCD protocol. A patient needs to be evaluated for airway, breathing, circulation and neurological disability. Any patient that has sustained a head injury and appears confused or is unconscious should be considered to have a traumatic spinal injury. If the patient is alert and indicates they have spinal pain, numbness or weakness the same assumption applies. Any presumed spinal injury should be handled with extreme care and the patient should be immobilized.
Using a log-roll technique, the patient should be placed onto a backboard for transfer. Use the same technique to apply a rigid cervical collar.
Patients that are being evaluated in the emergency department follow the same ABCD scheme. Any injuries that are life-threatening take priority over the presumed spinal injury. Some injuries that fall in that category include breathing difficulties, systematic bleeding or a pneumothorax.
- Standard vital signs that include blood pressure, temperature, heart rate and respiratory status should be monitored. Using capnography as a respiratory status monitor is standard emergency department procedure.
- A patient that has endured an injury high on the cervical cord may have difficulty breathing. They may need airway suction or intubation in order to get adequate air. Approximately one-third of those who have suffered a cervical injury will need mechanical respiratory support. This usually will need to happen within 24 hours of the injury. Using rapid-sequence intubation with in-line spinal immobilization is the ideal method when an airway is needed immediately. In cases where time is not a factor, a fiber optic laryngoscope intubation method is generally a safer option.
- A patient suffering from facial hypoxia may be harmful to their neurological outcome. It is imperative arterial oxygenation is monitored with supplementation when needed.
- Hypotension is possible because of a lack of blood caused by other injuries. Blood pooling in the extremities that are lacking sympathetic tone due to the interruption of the autonomic nerve system can also cause hypotension. The resulting hypoperfusion can cause permanent damage. Elevating the legs and head if possible, a blood transfusion or administering vasoactive medications may be necessary.
- The immobilization of the neck and body must not be removed until the spinal injury has been ruled on. The cervical collar, blocks, tape, straps and any athletic headgear should remain in place until the ruling is in.
- The patient should be given a neurological exam as soon as possible. This will determine the level and severity of an injury, which are important for prognosis and determining a treatment plan. Assessing mental status and cranial nerve function is also a good idea as many TCSI patients have endured a head injury.
- A bladder distention evaluation should be completed as well by palpation or ultrasound. The patient should have a urinary catheter inserted to avoid any further harm to the bladder caused by distention.