Overview
This lecture covers the concepts of primary and secondary spinal cord injury, trauma management protocols, and the importance of immobilization in preventing further injury.
Primary vs. Secondary Spinal Cord Injury
- Primary injury is the initial trauma to the spinal cord, such as from a fall or car accident.
- It involves mechanical forces (compression, distraction) that directly disrupt neural pathways and blood supply.
- Primary injury is mostly irreversible, so prevention (e.g., better car seat belts) is key.
- Surgically removing compression on the spinal cord can sometimes reduce primary injury severity if done quickly.
- Secondary injury includes ongoing cellular, biochemical, and molecular changes after the initial trauma.
- Secondary injury can last into the chronic phase and includes inflammation, reduced blood flow, and oxidative damage.
- Preventing secondary injury is a major treatment focus, mainly through medical (not surgical) interventions.
Initial Trauma Management (ABCDEs)
- Spinal cord injuries are managed like any other trauma using the ABCDE approach.
- A: Airway management.
- B: Breathing and ventilation assessment.
- C: Circulation and hemorrhage control.
- D: Disability, including neurological examination.
- E: Exposure and examination for other injuries.
- Following trauma protocols (like ATLS) is essential for proper care.
Immobilization and Spinal Precautions
- Immobilization is crucial to prevent further primary injury, especially in unstable spinal cases.
- EMS applies a Philadelphia collar and backboard for transport to the hospital.
- Remove patients from backboards as soon as possible to prevent pressure sores, always using log rolling and spine precautions.
- Cervical immobilization is critical in suspected cervical injuries, using collars, braces, or even a halo device.
- Extremely unstable cases may require urgent surgical intervention.
Key Terms & Definitions
- Primary Injury — Direct trauma to the spinal cord at the moment of injury.
- Secondary Injury — Cellular and molecular changes causing further neurologic damage after the initial trauma.
- Immobilization — Stabilizing the spine to prevent additional injury.
- ATLS — Advanced Trauma Life Support; a protocol for trauma care using ABCDE steps.
Action Items / Next Steps
- Review the ABCDE trauma management protocol.
- Learn different types of cervical immobilization devices.
- Understand primary vs. secondary injury mechanisms and prevention strategies.