Q) Out of the following, which patient requires spinal immobilization the most?
A. 22-year-old female involved in a high-speed motor vehicle collision who complains of back pain but has no numbness
B. 16-year-old male who jumped from a 6 ft height and landed on both feet, denies back pain and weakness
C. Gunshot injury
D. Abdominal injury
A. 22-year-old female involved in a high-speed motor vehicle collision with back pain
Spinal immobilization is most indicated when there's a high-risk mechanism of injury with suggestive symptoms, such as midline spinal pain or neurological signs.
A involves a high-energy mechanism (MVC) and reported back pain, which is a clear indication for spinal immobilization per NEXUS and Canadian C-spine rules.
B has a lower-risk mechanism and no symptoms; thus, spinal immobilization is generally not needed.
C – Gunshot wounds may or may not need spinal immobilization depending on location and neurological findings; not always indicated unless spinal structures are involved.
D – Isolated abdominal trauma is not an indication for spinal immobilization unless there’s evidence of spinal involvement.
Mechanism of injury
Blunt trauma - Direct impingement, Ischemia, compression or bleeding
Penetrating - Laceration of spinal cord
Chance fracture - is a type of spinal cord fracture in which there is transverse fracture of all vertebral elements
Management
1 Complete immobilisation
2. Management of associated neurogenic shock ( due to loss of sympathetic tone) with vasopressors and fluids
