Inmediate care of the spinal injured - at the site of trauma and at the emergency room

Abstract

In the USA roughly 50 traumatic spinal cord injuries will be found pr. million inhabitants pr. year which in Demmark indicate that we will see 250 new cases pr. year. First aid treatment should lead to avoid any further damage than that obtained at the injury moment. Afier trauma site it is therefore important to get the idea of the possibility of a spinal cord injury. In practic life this is not ofien so. Therefore education of people who takes care of the emergency treatment seems very important including ambulance, chauffeurs and other personal. The spinal cord lesion is often over looked if the patient is in shock, unconscious or if awake do not experience severe neckpain. The evaluation of the patient at the accident scene starts with a survey where specific attention is paid to airway, maintenance and breathing and to that of circulation. With ventilation problems and no signs of chest injury a high cervicallesion should be anticipated. If possible, head and neck must never be hyperflexed or hyperextended but kept straight forward being the safest way of treatment until a firm diagnosis can be established. Signs of severe maxillofaciala trauma indicates always a possible spinal cord injury, despite absence of neurological deficits. Extrication from a vehicle needs proper thinking and sometimes it is better to leave the patient for a short while until expert arrive than to try to drag them out with collision of head against steering, wheel or front window. The upper airway must always be kept clean, and if intubation must be carried out it should be done by a skilled person if ever possible. Manual ventilation with a mask is preferable for a short periode if the expert is not nearly. The nasal tracheal intubation is advocated compared to endotracheal intubation as the degree of hyperextension created is less . If the patient is in shock if you can feel the radial pulse, the systolic bloodpressure is approximatel 80 mmHg, if the femoral pulse can be feIt is around 70 mmHg and if only the carotid pulse is palpable the systolic pressure