[Music] um the first concept to introduce in spinal cord injury management is the concept of primary versus secondary injury the primary injury is the trauma sustained by the spinal cord whether that is a fall um a motor vehicle accident or whatever um that happens to the you know to is what happens to the spinal cord at the moment of injury and it can include mechanical forces like compression distraction or other non-physiologic forces that the spinal cord is really not designed to withstand those forces directly disrupt neural pathways and vascular supply and primary injury can't really be reversed so the main focus um you know for public health measures is in prevention of this such as you know removing lap belts from the back seats of cars and replacing them with shoulder seat belts um although you can sometimes actually affect primary injury severity by surgically removing points of anatomic compression on the spinal cord in a timely fashion the secondary injury refers to cellular biomechanical biochemical or even molecular changes that continue neurologic injury after the moment of the primary injury and while we generally think of these as acute processes they can last into the chronic phase of recovery and we'll talk about a couple of those secondary injury can include inflammatory responses hypoperfusion oxidative damage and ultimately these changes result in histologic remodeling of the spinal cord and as we'll see preventing secondary injury is a huge part of spinal cord injury management which we largely do through medical not surgical means so all spinal cord injuries are generally going to be traumas so while atls is outside the scope of this talk i do think it's important to emphasize that you want to always treat these traumas just like every other trauma you use the abcdes of trauma and you can see those here and of course atls has excellent interactive courses on this in order to be certified in this care and basically a is for airway and b is breathing and ventilation c is going to be for circulation and hemorrhage control d is disability and that includes your neuro exam right there and then e is exposure including looking for other injuries that may be associated and immobilization is a central part of not causing more primary injury to the spinal cord because in a highly unstable spine manipulation of the spine can cause ongoing or even new and worsening injury to the spinal cord immobilization is done in the field usually through a philadelphia collar and a backboard by ems for transport into the emergency room and one of the important atls directives of course is to remove people from the backboard as soon as possible to avoid pressure sores but that's always done via log rolling and spine precautions are always maintained cervical immobilization needs to be paramount especially when a person is suspected to have a cervical spinal cord injury in order to prevent further cord injury from a highly unstable spine and this is done through a variety of cervical collars or braces in some cases a halo may even be needed but in general if they're that unstable in our practice my institution would generally just operate urgently [Music] hey everyone ryan rad here from neurosurgery training dot org if you like that video subscribe and donate to keep our content available for medical students across the world