Treatment of spinal injuries - medication and shock management/first aid

Injury treatment begins at the site of the injury. This is not a pharmacological treatment, but rather first aid and regimental changes.

It is important to follow 5 basic principles - silence, warmth, no fluids, pain relief and transport

5 rules of first responder's shock management:

1. silence - in the immediate environment of the victim
2. warmth - prevent heat loss, in the hot summer sun - prevent overheating and exposure to direct sunlight
3. no fluids = do not give the victim anything to drink or eat, not even water
4. pain relief = limb fixation, place the injured limb correct position until the arrival of medical professionals, do not move the victim
5. transport - proper care of the victim during transport, call for medical attention

When providing first aid, as well as professional pre-hospital care, it is important to find out the mechanism of the accident. If a spinal cord injury is suspected, proceed in such a way that careless handling does not worsen the condition.

It is important to call an ambulance or, in the event of an accident, call the emergency line for professional help in your country or the emergency number 112 from anywhere within the EU.

It is necessary to communicate calmly and answer all the questions.

First, determine the victim's alertness and the state of consciousness, breathing and bleeding. Continue providing appropriate first aid.

The cervical spine needs to be immobilised. You can provide either immobilisation or neck support.

During the time the ambulance needs to get to the location of the accident, we repeatedly check whether the victim is conscious and breathing. The victim must not move. Nothing can be inserted into the victim's mouth, even if they are very thirsty.

The exception is when we are performing life-saving tasks, such as when the victim stops breathing, blood circulation problem and bleeding.

For example, a burning car and or unconscious person are such life-threatening situations.

In these cases, the victim should be moved by several people and transported in such a way that the spine and the neck are fixed in place, if time constraints allow.

When providing first aid, rescuers need to take care of themselves, too.

The correct position should ensure that the injured body and head are in one axis, which will ensure a better position for the whole spine.

The easy and fast way = kneel behind the victim's head and keep the head on the hips in a firm grip, and do not move it.

Stay that way until medical help arrives and take over the care for the victim.

If the victim is unconscious, the same first-responder principles apply, except if the airways need to be cleared. In case of obvious difficulty breathing, the victim's head should be carefully and slightly tilted.

Of course, we still maintain a suitable head position.

A serious condition is a respiratory disorder or respiratory arrest that persists after clearing the airways. At that moment, we continue with chest compressions (rhythmically pushing down on the chest, CPR = cardiopulmonary resuscitation).

The head must not be moved if the cervical spine is injured.

The task is to maintain congestion of vital organs, especially the brain, heart and lungs.

The compression-to-ventilation ratio, as perfrormed by trained rescuers, is 30:2.
If CPR is performed by a person without first aid training, it is continued only by compressions at a frequency of 100 per minute. Their depth should be 5 to 6 centimeters.

If you don't remember the procedure, it doesn't matter.

In any case, call back your local emergency number, inform them of the deteriorating condition and the operator will guide you through the correct resuscitation procedure.

In these situations, resuscitation takes precedence over anything else. Damaged spinal cord may not be the cause of circulatory and respiratory arrest. However, this is not excluded.

When calling either your local or the international emergency number 112:

• remain calm, stress can make mutual comprehension difficult, speak naturally and understandably
• cooperate with the operator
• the following information is to be reported:
  • who is calling (whether the caller is a witness or a participant in the accident, sharing any names is not important to save the injured)
  • where it happened
    • give some landmarks
    • unknown location - use GPS coordinates
    • use any app that is able to locate you
  • what happened - type of event, traffic accident, motorcycle, bus and others
  • who is the victim - the number of injured persons, at least by estimation in case more people are injured
  • when it happened
  • other questions that might be asked by the emergency operator:
    • injuries
    • safety
    • first aid provided
    • provides first aid instructions
    • explains how to give a CPR until the arrival of medical professionals

Professional treatment

The purpose of treatment is to alleviate the consequences and complications of spinal cord injury. Early patient mobilisation, rehabilitation and psychological support are important.

Serious spinal cord injuries with present neurological deficits are a major change in human life that has a negative impact on the mental state. And from several aspects.

Professional help is given at the location of the accident by means of care, positioning and fixing the victim to get ready for transport.

The victim is intubated (with a cannula for tracheal intubation) to bring breathing under control in case of a respiratory arrest or difficulty breathing.

This is followed by a check on vital signs that will determine further professional treatment. The first neurological examination is performed both on site and in the hospital.

Corticosteroids, oxygen, shock therapy, fluid replacement, and lost blood replacement are given as part of pharmacological treatment.

If necessary, neurosurgery is performed, e.g. to stabilise the spine and decompress, i.e. release the pressure in, the spinal cord.

Later on during the treatment, rehabilitation, nursing care, repositioning and prevention of pressure ulcers (bedsores)are all very important as the patient is immobilised.

Besides preventing bedsores, it is important to take certain measures to prevent immobilised people from developing pneumonia, urinary tract infections, bedsores on the skin, and get them used to drinking lots of fluids.