After the primary survey assessing the patient's airway, breathing, circulation, and disability, obtain a focused trauma history in the SAMPLE format:
• Signs and symptoms: Ask specifically about neck pain, paresthesias, paralysis, and paresis. Assess for level of consciousness and ingestion of intoxicants. Ask about concussive symptoms and about pain from any other parts of the body to determine whether there is a concurrent head injury or any distracting injuries.
• Past medical history: General past history should include long-standing and acute health conditions, previous injuries, and/or surgeries. Special attention should be paid to previous spinal injuries/surgeries and conditions that would predispose to spinal injury, such as Down syndrome, Klippel-Feil syndrome, achondroplasia, mucopolysaccharidosis, Ehlers-Danlos syndrome, Marfan syndrome, osteogenesis imperfecta, Larsen syndrome, juvenile rheumatoid arthritis, juvenile ankylosing spondylitis, renal osteodystrophy, or rickets.3
• Last meal: This is important to determine risk of vomiting while boarded, stabilized, or during airway intervention.
• Events leading up to the injury (the mechanism of injury is most important): (1) MVC: Ask about speed, ejection, rollover, seating position, point of impact, injuries to or death of other occupants, and involvement of a motorized recreational vehicle or bicycle; (2) Sports: Ascertain the sport engaged in (particularly diving), as there may be an axial loading mechanism; (3) Falls: Determine the height of the fall or number of stairs descended. (4) All mechanisms: Ask if the patient was ambulatory at the scene or sitting up after the injury. Physical Examination A secondary survey consists of a complete physical examination, looking for injuries not identified in the primary survey. The majority of signs of spinal injury will be found during this phase of the evaluation. While a head-to-toe evaluation is important for all trauma patients, there are several features that are particularly important in the investigation of spinal injuries. Common physical signs of spinal injury are listed in Table 4.
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