The algorithm in step “”A”" named
“”Airway maintenance and cervical spine protection”" includes the establishment of a patent airway in association with buy Semaxanib application of a stiff-neck in the unconscious patient and the conscious patient with substantial neck pain following injury. Going through the A, B, C, D, Es a strong suspicion for spinal cord injury is entertained (see Figure 1). Specific problems arise with the patient being unconscious. Motor and sensory exam are hampered and the investigator has to rely on pathologic reflexes and weak muscle tone. Priapism and low rectal sphincter tone may count for neurological impairment e.g. paraplegia [24, 25]. Figure 1 ATLS ® algorithm and spine trauma assessment. In Step „A”" cervical spine (C-Spine) protection is indispensable. Every unconscious patient is stabilized by stiff-neck. Patients with signs of chest injury in step „B”" and abdominal injury in step „C”", especially retroperitoneal are highly suspicious for thoracic (T-) and/or (L-) lumbar spine injury. Normal motor exam
and reflexes do not rule out significant spine injury in the comatose patient. Abnormal neurologic exam is a sign for substantial spinal column injury including spinal cord injury (SCI). Log roll in step „E”" is important to assess the dorsum of the cervical to the CB-839 molecular weight sacral spine and to look out for any signs of bruising, open wounds, tender points and to palpate the paravertebral tissue and posterior processus in search for distraction injury. Spine precautions should only be discontinued when patients gain back consciousness
and are alert to communicate sufficiently on spinal discomfort or neurologic sensations before the spine HSP90 is cleared. Since hypotension and ischemia-reperfusion are known factors for exacerbation of detrimental secondary immunologic events [2, 40], the restoration of a sufficient cardiopulmonary function and consecutively constant arterial mean pressure is indispensable to maintain sufficient organ perfusion with special regard towards injuries of the central nervous system including the brain and the myelon [41, 42]. This is further emphasized by the fact that immunologic secondary events following primary mechanical injury to the spinal cord and even the intervertebral disc might interact substantially with systemic immune reactions [43, 44]. In consequence and according to the ATLS® protocol in step B and C, early oxygenation and aggressive volume replacement is highly important [39]. The ATLS®-protocol also emphasizes the “”log roll”" in step “”E”" to visually inspect and manually examine the dorsal structures of the spine. The investigator can find signs of spinal trauma e.g. bruising and by palpating the processi STA-9090 spinosi which might be fractured or show a widened space in between, all of which counting for substantial spinal trauma [45].
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