(2) Check for normal movement of toes and fingers. Does the patient feel
normal sensation? Can the patient tell when some one is moving his (the patient's)
finger or toes up or down?
(3) Does the patient feel pain in response to a pin prick? Start at the
patient's feet and move upward. Mark the level at which the patient first feels the pin
A normal neurologic examination does not rule out the possibility that the
patient has a spinal cord injury. Persons who have been in accidents
involving automobiles, motorcycles, trucks, etc. have walked away from
the accident. Hours later the individuals have become totally paralyzed
after a nod of the head which squeezed an unstable vertebral column
down against the spinal cord. Therefore, when the mechanism of injury
suggests that the patient could have a spinal cord injury, treat him as
though he does have such an injury, regardless of the neurologic findings.
c. Motor Function Check.
(1) Can the patient wiggle his toes? Fingers? If not, can he move his
wrists, elbows, etc.?
(2) If the patient is unconscious, test with a noxious stimulus and observe
him for signs of withdrawal.
REMEMBER: Assessment is NOT to determine whether the patient should be
immobilized, but to establish the patient's condition at the moment of
5-18. TREATMENT FOR SPINAL CORD INJURY
The goal of treatment for spinal cord injury is to support the patient's vital
functions and prevent further damage. Remember that improper handling of a patient
with a spinal injury can cause permanent paralysis. As with assessment, begin the
treatment with the ABCs of airway, breathing, and circulation. Then, add the C of
cervical spine stabilization and other elements of treatment.
a. A - Airway. Ensure that secretions are not blocking the airway. Have suction
equipment available. You may need to clear the airway frequently of blood, saliva, or
vomitus. Assure that the airway is open without using the head-tilt method. If
movement of the head is necessary to restore an adequate airway, use the jaw-thrust