Adult Spinal Injury

Question 1

When is a SCI suspected or Major trauma?

Answer 1

• Major Trauma following blunt trauma to the head or trunk
• Neurological deficit

Question 2

What is the mx for Suspected SCI or Major Trauma

Answer 2

• Spinal Immobilisation
• Extricate on combi-carrier if necessary
• Consider prophylactic antiemetic
• Tx as per trauma Triage

Question 3

What is the Mx for Isolated Spinal cord injury?

Answer 3

• Nasal Capnography
• Normal Saline 500mL IV if BP <120mmHg

Question 4

What are the risk factors for SCI?

Answer 4

• Increased Injury risk (Age >= 65, Hx vertebral disease/abnormalities)
• Difficult Ax (Altered Conscious state, Intoxication, Significant Distracting injury)
• Evidence of structural injury (Midline pain/Tenderness in palpation)
• Reduced neck range of motion (Unable to rotate neck 45degrees Left and Right)

Question 5

What is the Mx if Cervical spine is not cleared?

Answer 5

ONE OR MORE CRITERIA
- Spinal Immobilisation
- Extricate on Combi-carrier if necessary
- Consider prophylactic Antiemetic

Question 6

When should Self-extrication be considered if the patient has not had their C-Spine cleared?

Answer 6

• Conscious and Co-operative
• Not intoxicated
• Not prevented by injury

Question 7

What are the care objectives of Spinal Injury

Answer 7

• Identify patients with suspected SCI and transfer them to appropriate facility
• To protect and support the integrity of the spinal column where SCI is suspected or unstable vertebral injury cannot be excluded
• To avoid unnecessary immobilisation by clinically excluding patients iwthout injury to the spinal column

Question 8

What is primary Spinal Cord injury?

Answer 8

• Direct injury to the spinal cord

Question 9

What is secondary spinal cord injury ?

Answer 9

• Subsequent injury caused by hypoxia, Hypotension, Oedema/haemorrhage causing compression and ischaemia

Question 10

What are the characteristics of Central Cord Syndrome

Answer 10

• Caused by striking the chin/Face and extending the neck
• Common type of SCI in elderly patients following standing heigh fall
• Greater deficits in the arms than in hte legs

Question 11

What are the characteristics of Brown Sequard Syndrome

Answer 11

• Dysfunction differing between the patients left and right side
• Motor one side
• Senesation the other side

Question 12

What are the characteristics of anterior cord syndrome

Answer 12

• Bilateral motor dysfunction below the level of the injury
• Degrees of sensory dysfuinction
• Pain and temperature sensation may be altered
• Touch may be normal

Question 13

What are the characteristics of Conus Medullaris and Cauda Equina Syndrome

Answer 13

• Affects distal end of the spinal cord
• Can impact bladder, bowel and low limb function and sensation

Question 14

What are signs of neurogenic shock?

Answer 14

• Hypotension
• Bradycardia
• Flushed warm skin
• Hypothermia

Question 15

What is spinal shock?

Answer 15

• transient loss of usual neurological activity at and below level of injury
• Due to swelling and ischaemia to spinal cord