C-spine fracture

Question 1

A 34 year old woman falls off her horse and is brought by ambulance to the emergency department. She reports that she cannot move her arms and legs.

Initial observations are:
Pulse 48 BP 80/50 Sats 97% on air GCS 15

Her ABC primary survey shows no further abnormalities. On examination she is unable to move her arms and legs with associated loss of sensation

Answer 1

-

Question 2

1. What is the likely cause of her hypotension and what is the physiological mechanism for this? (2 marks)

Answer 2

Neurogenic shock

Loss of background sympathetic stimulation to vessels causing vasodilation

Question 3

2. Name two ways her hypotension could be managed? (2 marks)

Answer 3

1. Intravenous fluids

2. Inotropes/vasopressors

Question 4

3. Name two radiological tests she requires in the resuscitation room? (2 marks)

Answer 4

1. CXR
2. Pelvis xray
3. FAST Scan

Question 5

4. Her CT Scan shows a displaced spinal fracture at the level of C5. What worrying sign are you worried she may develop? (1 mark)

Answer 5

Inability to breathe

Hypoxia

Question 6

5. She remains tetraplegic. Name three other aspects of her treatment in the emergency department. (3 marks)

Answer 6

1. LMWH
2. Anti-thrombotic socks
3. PPI
4. Urinary catheter