Adult Spinal Injury

Question 1

Spinal Injury Mgx SD3

Answer 1

1. R+R
2. Position – Supine
3. Collar
4. O2 NRB 15L/min
5. MICA
6. IV Access
7. Pain Relief
8. Antiemetic Prophylactic
9. If BP <90mmHg - NS 10mL/kg (isolated SCI)
10. Warm patient
11. Sitrep MICA
12. Extrication – Combi to stretcher
13. Load Signal 1 with notification – MICA?

Question 2

Anatomy of Spinal Cord

Answer 2

• 7 Cervical Vertebrae
• 12 Thoracic Vertebrae
• 5 Lumbar Vertebrae
  o 5 fused Sacrum Vertebrae
  o 4 fused Coccyx Vertebrae

Question 3

Question 1: Why is Spinal Cord Injury a modifying factor for fluid administration?

Answer 3

 Fluid overload may lead to pulmonary oedema due to capillary integrity of the pulmonary circulation being impaired as a result of the catecholamine surge.
 Similarly this is a form of relative hypovolaemia. The issue with these patients is not that they don’t have enough circulating volume but rather they cannot vasoconstrict their vessels to increase BP.

Question 4

In accordance with AV CPG’s what age is utilised in the modified nexus criteria to classify a patient at an ‘increased risk’ requiring spinal immobilisation?

Answer 4

≥65yrs

Question 5

What is the NEXUS Criteria

Answer 5

Increased injury risk
- pt≥65yrs
- hx of bone weakening disease/injury
Difficult pt assessment
- altered conscious state
- intoxicated
- significant distracting injury
Actual evidence of structured injury
- midline pain/tenderness on palpation of the vertebrae
Neck range of motion
- pt is unable to actively rotate neck 45º without pain

Question 6

Loss of airway control would be the result of spinal cord
transection at what level?

Answer 6

Damage to the high cervical nerves (c1-c4) would cause a patient to lose their airway control

Question 7

What is neurogenic shock and how is it related to spinal cord injuries?

Answer 7

Neurogenic shock is the loss of normal vasomotor tone below the level of injury, where
normal vasomotor tone through sympathetic nervous system is lost
Injury to thoracic spine or above
↓
Interruption of sympathetic outflow from spinal cord nerves
↓
Release of noradrenaline (Brief rise in BP)
↓
Vagal tone unopposed from intact cranial vagus nerve
↓
Hypotension/bradycardia and vasodilation with nil sympathetic response

Question 8

What is the dose of Fentanyl used to treat moderate pain for a small child and what are the repeat and maximum doses?

Answer 8

Small child (10-17kg): 25mcg IN
Repeat initial dose at 5 – 10 minute intervals
Consult after 3 doses

Question 9

Pathophysiology of C3 and T1 Spinal Injury

Answer 9

• C3, 4, 5 – Diaphragm impairment
• C6, 6 through to T4 – impaired intercoastal muscles and decreased tidal volume
• T1 through T4 – impaired sympathetic outflow, causes unopposed vagal stimulation leading to bradycardia
• T12 – paraplegia and vasodilation of legs leading to hypotension and tachycardia

Question 10

Secondary Cord Injury

Answer 10

• A spinal cord injury caused by
  o Poor handling
  o Hypoxia
  o Hypotension
  o Intrinsic metabolic changes – causing ischemia, inflammation and oedema

Question 11

Indications for Collar

Answer 11

Major trauma after blunt force trauma to the head or trunk
Neurological Deficits or change

Question 12

Contraindications for Collar

Answer 12

Surgical airway
Penetrating neck trauma
Unable to achieve neutral position*

Question 13

Contraindications for Collar

Answer 13

Surgical airway
Penetrating neck trauma
Unable to achieve neutral position*