1.10 C Spine Trauma

Question 1

Techniques to minmise 2ndary spinal cord injury while securing an airway

Answer 1

1. Assessment
   - No ability to asses ROM @ oaa jxn
   - MO + jaw slide inhib collar
   - reduced consciousness - difficult assess
2. Familiarity vs suitability prevent further injury
3. 2nd Senior involved
   environment - theatre
   assistant
4. DAS equipment
5. Difficult - AFOI?
   semi conc / fractures / obstruct - risk failure / complication
6. Basic manoeuvre - displace c spine
   RSI safest in predicted easy
   little added risk w/ manual inline stabilization
7. Sux acceptable early stage
8. Neuro injury
   more likely - second to low perfusion

Question 2

Anaesthetic management of cord injury - 6months post high spinal injury

CNS

Answer 2

1. CNS

Hypertonic / hyperreflexia

ANS dysreflexia nociceptive and proprioception below lesion

Difficult assessment assoc TBI / altered affect

Assess pain challenged

Question 3

Difficulties airway

Answer 3

Potential difficult tube

limited movement

Sux avoid
risk arrhythmia second to arrest - High K

Question 4

Resp difficulies

Answer 4

Lower spirometry value
FRC VC

poor cough and clearance
aspiration / post op infection

Phrenic nerve fxn impairment if c4
asses flow vol loop
video fluoroscopy

vent better supine cephalic diaphragm displacement

Increase post op resp support

Question 5

CVS difficulties

Answer 5

Postural hypotension

consequence ANS dysreflexia
brady hypertension
acute MI HFAIL APO
sublingual GTN

exag response to hypo tension follow loss/blocks

Question 6

GI GU diffciul

Answer 6

Modified rsi
risk aspiration d/t delayed emptying

GU
UTI - catheter
poor emptying
risk stones / sepsis 
failure

Question 7

Other risk

Answer 7

DVT

OSteoprosis + # - care transfer

positioning - contractures

thermoregulation

malnutrition