Synopsis
Localise acute spinal-cord injury, distinguish neurogenic from haemorrhagic shock, protect respiratory and cord perfusion, and communicate a reproducible neurological level and completeness assessment.
- Protect alignment while prioritising airway and breathing; high cervical injury can retain a normal early saturation despite falling ventilation and ineffective cough.
- Document a structured motor and sensory examination, including perianal sensation, deep anal pressure and voluntary anal contraction when clinically appropriate to determine sacral sparing.
- The neurological level is the most caudal segment with normal sensory and antigravity motor function under the ISNCSCI method; do not infer it from one weak limb.
Key red flags
Diaphragmatic breathing, weak cough, falling vital capacity, hypercapnia or high cervical weakness requires early anaesthetic and critical-care support before oxygen saturation falls.
Investigation priorities
Localise level, completeness and change over time.
Define fracture, translation, canal bone and alignment rapidly.
Management branches
Trauma produces weakness, sensory level, sacral change or high-risk spinal pain.
- Run ABCDE with coordinated spinal protection, give oxygen when required and call anaesthetic support for weak cough, hypoventilation or high cervical injury.
- Document a structured motor, sensory and sacral examination before and after transfers or reduction whenever feasible.
Key medicines
Noradrenaline infusion for selected neurogenic shockStart only in a monitored critical-care setting after adequate volume and haemorrhage control, using the local standard concentration and titrating the intravenous infusion to the spinal-team perfusion target; there is no single safe fixed trauma dose.