Spinal assessment

UNCONTROLLED WHEN PRINTED

Quick Chart

Indications

Contraindications

Patient Factors & Considerations

C-Spine assessment is performed using clinical judgement and findings from examinations, the NEXUS Clinical Decision Rule can be used to aid this decision.
Prior to clearance a thorough primary/secondary and Neurological survey must be completed.
Asses high risk factors that limit the ability to clear C spine
Patients with no neurological deficit may self-extricate short distances (a few steps)
Careful clinical judgment should be used, if self-extrication is likely to aggravate the injury then alternative methods of extrication should be used.
Ensure a Lanyard is placed and education is given on self-splinting prior to self-extrication.
Once on the stretcher apply head blocks and treat although a spinal injury is present.

High risk factors include:

Age: Older than 65 years
Known pre-existing spinal conditions (e.g. ankylosing spondylitis, rheumatoid arthritis, spinal surgery, spinal stenosis etc.)
Dangerous mechanism(s) of injury, including but not limited to:
- Fall: ≥ 1 meter OR 5 stairs
- High axial loading to the head (e.g. diving, rugby scrum, surfing etc.)
- Motor Vehicle Collision at high speed (≥ 60km/hr)
- Motor Vehicle Rollover
- Ejection from a vehicle
- Accidents involving motorised recreational vehicles (e.g. quad-bikes, ATV's, motorbikes, etc.)
- Bicycle collision
- Pedestrian/s struck by vehicle
Abnormal neurological status
- Obvious or subtle numbness, tingling or strength deficit in peripheries which was not present prior to the incident/injury

Procedure

The NEXUS criteria stipulates that cervical spine injury cannot be excluded if any of the following criteria are present:

Posterior midline cervical spine tenderness:
- Tenderness is considered present in the following circumstances:
  - Pain on palpation of the posterior midline cervical spine from nuchal ridge to the prominence of the first thoracic vertebra OR
  - Pain on direct palpation of any cervical spinous process
Altered Mental Status (including any of the following):

Focal neurological deficit:
- Determined to be ANY abnormality, be it sensory or motor on examination, either reported by the patient or elicited by the examiner
  CAUTION: Do not look for alternative explanations for neurological deficit; if present, assume spinal cord injury
Evidence of intoxication (including but not limited to):
- Recent history reported by the patient or an observer of ingestion/consumption of an intoxicating substance (including but not limited to alcohol) OR
- Physical exam results indicative of intoxication such as:
  - Odour of alcohol
  - Slurred speech
  - Ataxia
  - Dysmetria or other cerebellar findings
  - Behaviour consistent with intoxication
  - Tests of bodily secretions which are positive for drugs (including but not limited to alcohol) that affect mental alertness
Painful distracting injuries

Painful distracting injuries can be considered as any condition thought by the clinician to be producing pain sufficient to distract the patient from a second (neck) injury. This may include (but is not limited to):

Click to expand

Success

Discontinue

Discontinue if patient non-compliant or not tolerant of hard collar and opt for manual in-line stabilisation or head-blocks only.

Additional Information

Additional information

References

Colour assist:

Directorate

Clinical Services

Responsible Manager

Head of Clinical Services

Published Date

Review Date