Suspected Cervical Spine Injury after a Motorbike Crash
At 16:40, a 22-year-old man is brought to a health center after a motorbike collided with a car. He was wearing a helmet, which is still on. He is drowsy but opens his eyes to voice, complains of neck pain, and says his hands feel numb. BP is 92/60 mmHg, pulse 118/min, respirations 24/min, and SpO2 is 95% on room air. His abdomen is tender in the left upper quadrant, the pelvis is stable, and there is a 5 cm abrasion on the right thigh but no active bleeding. The health center has oxygen, IV fluids, a rigid cervical collar, and a spine board but no doctor on site. The provincial hospital is 50 km away; the family wants to take him by moto taxi because the ambulance is not there.
1. State your primary survey and spinal precautions for this patient.
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Use a structured primary survey with manual in-line stabilization of the head and neck from the first contact. Assess danger and response, then airway: if he can speak, the airway is patent, but do not sit him up or allow flexion. The helmet should be removed only if it blocks the airway or ventilation, and only by two trained people maintaining in-line stabilization; otherwise leave it on until expert help is available. Breathing: give oxygen to keep SpO2 at least 94%, count respirations and check chest movement. Circulation: control any external bleeding, check pulse and capillary refill, and insert a large-bore IV. Disability: record GCS, pupils and limb movement; the numb hands suggest possible cord injury. Expose the abdomen and limbs while preventing heat loss. Apply a rigid cervical collar and log-roll him onto a spine board with head blocks. Reassess breathing and circulation after immobilization, because a tight collar or board can compromise the airway.
2. How will you manage his shock and organize transfer to the provincial hospital?
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He has clinical shock with a tender left upper quadrant, suggesting possible internal bleeding such as a splenic injury. Insert a large-bore IV and give a 500 mL Ringer's lactate bolus, then reassess BP, pulse, capillary refill and mental state. Repeat cautiously if he remains hypotensive; the aim is to restore a palpable radial pulse and improve consciousness without causing fluid overload before surgical control. Do not give oral fluids. Keep him warm and monitor every 15 minutes. Transfer is urgent because the health center cannot diagnose or treat internal bleeding or a spinal injury. Phone the provincial hospital, describe the mechanism, GCS, numbness, shock and suspected abdominal injury, and request an ambulance or experienced transfer vehicle. Continue oxygen, spinal immobilization and IV fluids en route. If he deteriorates, maintain the airway and cervical alignment; do not remove the collar. Document estimated blood loss, fluids given, vital signs and neurological findings before departure.
3. The family insists on a moto taxi. How do you respond?
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Acknowledge the family's fear and urgency, then explain clearly that a moto taxi cannot provide spinal immobilization, oxygen, IV fluids or monitoring, and that a fall or bump during the ride could permanently damage the spinal cord. He is also at risk of sudden deterioration from internal bleeding. Offer the safest available alternative: call the ambulance, ask another health facility or local authority for a vehicle, or use a pickup with a stretcher and spine board if no ambulance exists. If they still insist, do not physically block them, but document the refusal, the risks explained, and who made the decision. Insist that a nurse or trained escort accompany him, keep the collar and board in place, and give a referral note. Continue to encourage the safest option and involve the family in arranging it rather than simply refusing their request.