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.