PATIENT ASSESSMENT Basic points

PATIENT ASSESSMENT Basic points

The Advanced Trauma Life Support (ATLS) principles apply in all cases (see Chapters 26 and 27 ). The spine should initially be immobilised using full spinal precautions, on the assumption that every trauma patient has a spinal injury until proven otherwise ( Figure 30.10 ). The finding of a spinal injury makes it more (not less) likely that there will be a second injury at another level. Spinal boards lead to skin breakdown in insensate patients, and are very uncomfortable for those with normal sensation ( Figur e 30.11 ). They should only be used for transferring patients.

Figure 30.10 Spinal immobilisation. Figure 30.11 Pressure sores may develop rapidly in insensate patients.

Definitive clearance of the spine may not be possible in the initial stages; if this is the case, spinal immobilisation should be maintained until magnetic resonance imaging (MRI) or equivalent can be used to rule out an unstable spinal injury . Summary box 30.2 Patient assessment /uni25CF /uni25CF /uni25CF /uni25CF

Use ATLS principles in all cases of spinal injury In polytrauma cases suspect a spinal injury A second spinal injury at a remote level may be present in 10% of cases Spinal boards cause pressure sores

PATIENT ASSESSMENT Basic points

The Advanced Trauma Life Support (ATLS) principles apply in all cases (see Chapters 26 and 27 ). The spine should initially be immobilised using full spinal precautions, on the assumption that every trauma patient has a spinal injury until proven otherwise ( Figure 30.10 ). The finding of a spinal injury makes it more (not less) likely that there will be a second injury at another level. Spinal boards lead to skin breakdown in insensate patients, and are very uncomfortable for those with normal sensation ( Figur e 30.11 ). They should only be used for transferring patients.

Figure 30.10 Spinal immobilisation. Figure 30.11 Pressure sores may develop rapidly in insensate patients.

Definitive clearance of the spine may not be possible in the initial stages; if this is the case, spinal immobilisation should be maintained until magnetic resonance imaging (MRI) or equivalent can be used to rule out an unstable spinal injury . Summary box 30.2 Patient assessment /uni25CF /uni25CF /uni25CF /uni25CF

Use ATLS principles in all cases of spinal injury In polytrauma cases suspect a spinal injury A second spinal injury at a remote level may be present in 10% of cases Spinal boards cause pressure sores

PATIENT ASSESSMENT Basic points

The Advanced Trauma Life Support (ATLS) principles apply in all cases (see Chapters 26 and 27 ). The spine should initially be immobilised using full spinal precautions, on the assumption that every trauma patient has a spinal injury until proven otherwise ( Figure 30.10 ). The finding of a spinal injury makes it more (not less) likely that there will be a second injury at another level. Spinal boards lead to skin breakdown in insensate patients, and are very uncomfortable for those with normal sensation ( Figur e 30.11 ). They should only be used for transferring patients.

Figure 30.10 Spinal immobilisation. Figure 30.11 Pressure sores may develop rapidly in insensate patients.

Definitive clearance of the spine may not be possible in the initial stages; if this is the case, spinal immobilisation should be maintained until magnetic resonance imaging (MRI) or equivalent can be used to rule out an unstable spinal injury . Summary box 30.2 Patient assessment /uni25CF /uni25CF /uni25CF /uni25CF

Use ATLS principles in all cases of spinal injury In polytrauma cases suspect a spinal injury A second spinal injury at a remote level may be present in 10% of cases Spinal boards cause pressure sores