Selective Spinal Immobilization

Section 6 - TRAUMA

6.03 SELECTIVE SPINAL IMMOBILIZATION

• Consider Mechanism of Injury
  • Positive mechanism – Apply c-collar, consider full spinal immobilization
  • Negative mechanism – negative for spinal injury, no spinal packaging required
  • Uncertain mechanism – continue assessment → begin assessment for spine pain and/or tenderness

• Spinal restriction definition
  • At a minimum advise the reliable/cooperative patient to not move
  • If patient will tolerate it, place cervical collar on patient
  • Place patient on stretcher

• Spinal packaging definition
  • Place cervical collar on patient
  • Package pt on long backboard as long as it does not deteriorate patient condition

• Assess for spine pain and/or tenderness
  • Assessment reveals positive pain/tenderness – spinal restriction required
  • Assessment reveals – negative response regarding pain/tenderness → begin motor sensory exam

• Perform motor/sensory exam
  • Motor exam upper extremities
  • Motor exam lower extremities
  • Sensory exam
    • Presence/absence of abnormal sensation
    • Pain sensation upper extremities
    • Pain sensation lower extremities
• Abnormal – spinal packaging required
• Normal – begin reliable patient exam →

• Perform reliable patient exam
  • Patient exhibiting:
    • Acute stress reaction
    • Brain/head injury
    • Intoxication
    • Altered mental status
    • Suffering a distracting injury
    • Communications barrier – language, hearing impairment, toddlers, infants
• Unreliable – spinal packaging required
• Reliable - negative for spinal injury, patient calm, cooperative sober and alert

WHEN IN DOUBT, TREAT AS SPINAL INJURY