ATLS | Spinal Cord Injury

Patient Handling and Logrolling To safely manage a patient with potential spinal injuries, the team leader must determine the appropriate time to perform a logroll maneuver to examine the back and remove the backboard. This procedure requires strict coordination to maintain spinal alignment. One individual is assigned specifically to restrict head and neck motion, while others positioned on one side of the torso manually prevent the chest or abdomen from sagging, bending laterally, flexing, extending, or undergoing segmental rotation. Additional personnel are responsible for moving the legs and physically removing the backboard. Fluid Resuscitation and Shock Management When active hemorrhage is not evident, clinicians must distinguish between hypovolemic shock (typically presenting with tachycardia) and neurogenic shock (classically presenting with bradycardia) in patients with persistent hypotension. Treatment begins with a fluid challenge; however, if hypotension persists without occult hemorrhage, the judicious use of vasopressors—such as norepinephrine, dopamine, or phenylephrine hydrochloride—is recommended. It is critical to avoid overzealous fluid administration, as this can precipitate pulmonary edema in patients with neurogenic shock. If the patient's volume status remains uncertain, invasive monitoring or ultrasound estimation is advised. Furthermore, a urinary catheter should be inserted to prevent bladder distention and monitor output. Medication and Transfer Protocols Regarding pharmacological treatment, the source material notes there is insufficient evidence to support the use of steroids in spinal cord injury. Patients with neurological deficits or spine fractures should be transferred to a facility capable of providing definitive care, ideally following consultation with a spine specialist or the accepting trauma team leader. Before transfer, the patient must be stabilized with a semirigid cervical collar, backboard, and necessary splints. Special attention must be paid to airway management, as cervical spine injuries above C6 can result in the loss of respiratory function. If there is any concern regarding the adequacy of ventilation, clinicians should intubate the patient prior to transfer and strictly avoid unnecessary delays