Cervical spine injuries can cause severe neurologic deficits due to crushing, stretching, and rotational forces on the spinal cord. Any person with head, neck, back, upper leg, or pelvis injuries should be suspected of a potential spinal cord injury until proven otherwise. It is important to immediately immobilize the spine while assessing the patient's airway, breathing, circulation, and disability through a neurologic exam. High-flow oxygen and maintaining the patient's warmth and blood pressure are also critical to prevent further spinal cord damage.

1. Cervical
Spine Injuries
Kinna P. Siarro, RN

2. • Injuries to the cervical spine are
serious because the crushing,
stretching, and rotational shear
forces exerted on the cord at the time
of trauma can produce severe
neurologic deficits
• Edema and cord swelling contribute
further to the loss of spinal cord
function.

3. PRIMARY
ASSESSMENT

4. • Any person with a head, neck, or
back injury or fractures to the upper
leg bones or to the pelvis should be
suspected of having a potential spinal
cord injury until proved otherwise

5. • Provide immediate immobilization of
the spine while performing
assessment.
• Airway.
• Breathing.
• Intercostal paralysis with
diaphragmatic breathing indicates
cervical spinal cord injury.

6. • In conscious patient, observe for
increased respiratory rate and
difficulty in speaking due to
shortness of breath.
• Circulation.
• Disability—assess neurologic status.

7. PRIMARY
INTERVENTIONS

8. • Immobilize the cervical spine.
• Open the airway using the jaw-thrust
technique without head tilt.
• If the patient needs to be intubated,
it may be done nasally.

9. • If respirations are shallow, assist with
a bag-valve mask.
• Administer high-flow oxygen to
minimize potential hypoxic spinal
cord damage.

10. SUBSEQUENT
ASSESSMENT

11. • Assess the position of the patient
when found; this may indicate the
type of injury incurred.
• Hypotension and bradycardia
accompanied by warm, dry skin—
suggests spinal shock.
• Neck and back pain/extremity pain
or burning sensation to the skin.
• History of unconsciousness.

12. • Total sensory loss and motor
paralysis below level of injury.
• Loss of bowel and bladder control;
usually urinary retention and bladder
distention.
• Loss of sweating and vasomotor tone
below level of cord lesion.
• Priapism—persistent erection of
penis.

13. • Hypothermia—due to the inability to
constrict peripheral blood vessels
and conserve body heat.
• Loss of rectal tone.

14. GENERAL
INTERVENTIONS

15. NURSING ALERT
• A spinal cord injury can be made
worse during the acute phase of
injury, resulting in permanent
neurologic damage.
• Proper handling is an immediate
priority.

16. • Insert an NG tube.
• Keep the patient warm.
• Initiate I.V. access.
• Insert an indwelling urinary catheter to
avoid bladder distention.
• Monitor for hypotension, hypothermia, and
bradycardia.
• Continue with repeated neurologic
examinations to determine if there is
deterioration of the spinal cord injury.

17. • Be prepared to manage seizures.
• Pharmacologic interventions: high-dose
steroids (methylprednisolone).
• The standard regimen is 30 mg/kg I.V.
loading dose over 15 minutes, followed
by a 5.4 mg/kg/hour infusion to be
initiated 45 minutes later.
• Continue the infusion for 23 hours.