شاب عمره ١٩ سنة بعد قفزة في مسبح ضحل، عنده إصابة في الحبل الشوكي عند مستوى C4، لا يحرك أطرافه. التنفس ٢٨ وسطحي، والتشبع ٩٣٪، والضغط ٩٢/٥٨، والنبض ٥٦. ما الأولوية في الساعات الأولى؟

A 19-year-old dived into a shallow pool and has a C4 spinal cord injury with no limb movement. RR 28 and shallow, SpO2 93%, BP 92/58, HR 56. What is the priority in the first hours?

1. Starting walking exercises
2. Teaching self-catheterisation
3. Assessing sensation in the feet only, hourly
4. Monitoring breathing for diaphragm weakness

Answer: D) Monitoring breathing for diaphragm weakness. C3–C5 supply the diaphragm (“C3, 4, 5 keeps the diaphragm alive”), so a C4 injury can impair breathing; vital capacity is monitored and ventilation may be needed.