Best Treatment for Spinal Cord Injury in the Field
For patients with suspected spinal cord injury in the field, it is strongly recommended to immediately immobilize the spine with manual inline stabilization (MILS), maintain systolic blood pressure above 110 mmHg, and ensure proper airway management to prevent neurological deterioration. 1
Initial Assessment and Stabilization
Spinal Immobilization
- Apply early spine immobilization for any trauma patient with suspected spinal cord injury to limit neurological deficit progression 1
- Follow the algorithm for spinal immobilization:
- For life-threatening emergencies requiring quick extraction: Apply head-neck-chest stabilization
- For stable patients: Apply rigid neck brace, maintain head fixation, and use vacuum mattress for transport 1
- Open the cervical collar during intubation procedures to facilitate mouth opening and improve glottic exposure 1
Airway Management
- For patients with high cervical cord injuries (C4 or higher), immediate intubation is necessary 2
- During intubation, maintain manual inline stabilization (MILS) of the cervical spine to reduce complications 1
- Use rapid sequence intubation with direct laryngoscopy and a gum elastic bougie without Sellick maneuver to increase first-attempt success 1
Hemodynamic Management
- Maintain systolic blood pressure > 110 mmHg to reduce mortality 1
- Target mean arterial pressure of at least 70 mmHg to limit risk of neurological deterioration 1
- Avoid hypotension as it is an independent factor for increased mortality in SCI patients 1
Transport Considerations
- Transport patients directly to Level 1 trauma centers with full capabilities for diagnosis and treatment of spinal cord injuries 1
- Direct admission to specialized trauma centers is associated with:
- Earlier surgical procedures
- Reduced ICU length of stay
- Improved neurological outcomes 1
Common Pitfalls and Caveats
- The traditional use of backboards presents known risks including respiratory compromise, pain, and pressure sores without proven efficacy in protecting the spinal cord 3
- Using sandbags and tape alone for cervical spine immobilization is not recommended; instead, use a combination of rigid cervical collar and supportive blocks on a backboard with straps 4
- Remember that patients with SCI often have other bodily injuries - maintain a low threshold to assess for visceral, pelvic, and long bone injuries 2
- Respiratory mechanics are disrupted with any spinal cord lesion above T11, even in the absence of obvious respiratory distress 2
Additional Considerations
- Begin rehabilitation as soon as the patient is medically stable 5
- Monitor oxygen saturation and administer oxygen if saturation falls below 92% 5
- Elevate the head 15-30° if there is aspiration risk while maintaining spinal alignment 5
- Perform regular visual and tactile inspections to prevent pressure ulcers in immobilized patients 5