Care of the multiply injured patient with cervical spine injury.

Cervical spine injuries can be disastrous. The treatment begins at the accident scene by obtaining an appropriate history, physical examination, and evaluation of the mechanics of the accident. Emergency medical stabilization takes precedence, but the cervical spine should be stabilized until an injury in this area is ruled out. If the patient has suffered a head injury or is violent, cervical spine precautions should be maintained until spinal column injuries have been ruled out roentgenographically. Because of the complexities of the evaluation and treatment of cervical spine injury in the multiply injured patient, an algorithm to assist in the management and evaluation of the patient has been developed, and a multidisciplinary, specialized evaluation and treatment team is employed. Through this approach, mortality in the multiply injured patient with a cervical spine injury has been reduced to 22%. Of 58 patients with cervical spine injuries evaluated by this aggressive approach, 14 patients had associated spine fractures, and 9 patients had positive peritoneal lavage requiring surgical exploration. Injuries involving other organ systems were also diagnosed and treated. Formal, rigid evaluation plans and aggressive multidisciplinary treatment are useful in saving the lives and salvaging neurologic function of these patients.