A spinal cord injury is damage to the cord, most often from trauma such as car crashes, falls or sports, that disrupts strength, sensation and autonomic control below the level of injury. Early spinal protection and support of breathing and blood pressure help prevent further damage.
Key symptoms
- Neck or back pain after trauma
- Weakness or paralysis of the arms or legs
- Numbness or tingling below a certain level
- Loss of bladder or bowel control
- Trouble breathing with high neck injuries
What you find on exam
- Primary survey with spinal motion restriction
- Motor and sensory level using a standard scale
- Rectal tone and perianal sensation
- Low blood pressure with slow heart rate suggesting neurogenic shock
Tests
- CT of the spine for fractures
- MRI to see the cord, ligaments and disc injury
- Chest X-ray and blood gas if breathing is affected
- Bladder scan for urinary retention
Treatment basics
- Keep spinal motion restriction and log roll
- Airway support; early intubation for high cervical injuries
- IV fluids then vasopressors to keep mean arterial pressure around 85 to 90 mmHg
- Early spine surgery consult for decompression and stabilization
- Prevent pressure injuries, blood clots and bladder overdistension
Red flags
- Breathing difficulty or falling vital capacity
- Low blood pressure with slow heart rate
- Rising level of weakness or sensory loss
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NASEMSO National Model EMS Clinical Guidelines; NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.