C i.e. Maintain airway Initial Evaluation And Emergency Care In Spinal Trauma All the trauma patients are at risk of spinal injury. Many of the spinal injury patients are multiple trauma victims and there fore require emergency treatment(' The treatment priorities are preserving life (15, ), limb, and function. The spine must be protected as these priorities are addressed sequentially. (i.e. undue movements of spine are avoided)Q. The ABCs of trauma are followed in order of priority, with airway ventilation andcirculationQ being secured before fuher evaluation proceeds. Throughout the evaluation of other body systems, the cervical spine should be presumed injured and thus immobilized to avoid fuher neurological injury. Proper extrication of the patient and immobilization of cervical spine at the accident scene are critical to avoid fuher neurological injuryQ. The head and neck to be aligned with the long axis of trunk and immobilized in supine positionQ. Cervical extension should be avoided because it narrows the spinal canal more than flexionQ. Neutral flexion- extension head and neck alignment is optional(' during prehospital transpo of patients with cervical spine injury. Helmet & shoulder gear should be left in position until personnel trained in safe removal technque are available. After all life threatening injuries have been identified and stabilized, the secondary evaluation, including an extremity examination and neurological examination, can be safety carried out. When a spinal cord injury is suspected methyl prednisolone (steroid)Q should be staed. Most benefit occurs in the first 8 hoursQ, and additional effect occurs with in first 24 hours. The dose of methyl prednisolone is 30mg/kg loading doseQ + 5.4 mg/ kg/ hour x23 hourQ. When a medical center is reached, if a definitive cervical spine injury is identified & deemed unstable, skeletal traction for immobilization, reduction or both(' may be applied (eg. Gardner -wells traction, Halo traction etc) Summary of National Acute Spinal Cord Injury Study Protocols - Methyl prednisolone bolus 30 mg/ kg then infusion 5.4 mg/kg/h - Infusion for 24 hours if bolus given within 3 hours of injury - Infusion for 48 hrs if bolus given within 3 to 8 hrs of injury - No benefit if methyprednisolone staed more than 8 hours after injury - No benefit with naloxone - No benefit with tirilzad.