Cervical spine fracture

Question 1

Young girl underwent polytrauma By her bicycle with possible Neck injury and fracture.

Q1: How will you assess the patient?

Answer 1

According ATLS protocol

Question 2

Q2: what is the general principle of ATLS?

Answer 2

Airway and C Spine – breathing – Circulation – disability and exposure
manage each of them accordingly.

Question 3

Q5: your next investigation you would order ?

Answer 3

ABG / CXR / CT Chest / MRI cervical vertebrae

Question 3

Q3: Elaborate the breathing assessment in this patient?

Answer 3

RR and O2 sat
IPPA / Ispect; trauma – flial chest – bruisis
Palpate; trachea central, chest expansion
Percuss/ auscualt; for the air entry

Question 4

Q4: What will be the breathing problem in this patient and what is it’s effect on the lung ?

Answer 4

Neck injury will affect phernic N – > shallow breathing
Penuomothorax / Hemothorax – > Shallow breathing
this will lead to hypoxia , CO2 retention and alveolar collapse – > Res Acidosis

Question 5

Q6. Given the following MRI, what is the pathology ?

Answer 5

Displaced # of C6 – > compression of the spinal cord

NB; may have a displaced vertebrae due to
Spondylolisthesis (From the rapture of pars interarticularis)

Question 6

Q7. What is the significance of This fracture ?

Answer 6

Affect phernic N. – > affect Diaphragm  shallow breathing – Res Acid

Question 6

Q8: How will you assess the respiratory function of this patient ?

Answer 6

ABG

Question 6

Q9 : Given the following ABG (↓pH, ↑PCo2, Norm Bicarb) : Interpret ?

Answer 6

Uncompensated Respiratory Acidosis
C5 injury – Affect Phernic N – Weakness of diaphragm – Reduced Breathing effector – Shallow breathing – Accumlation of CO2 – Res Acid.

Question 7

Q. How to manage Res failure in ER ?

Answer 7

start by Workup for pt – inform consultant and ITU and anesthesia for intubation
Ventlation; we will start by non invasive like CPAP -BiPAP

Question 8

Q11: Why this patient have lower limb weakness ?

Answer 8

Because the spinal cord compression

Question 8

Q10: The decision is made to do fixation by Neurosurgery, what is one thing you will do before surgery ?

Answer 8

Triple Fixation of spine by Sandbags / Tape / Neck coller and take the conset for surgery form parents after explaining the early and late complications and risks. + Counselling with family + order Neck coller brace for after surgery
Early complication in this situation before surgery; Spinal shock
TTT; Iv fluids / phenylephrine / NorEpi / Dexamethasone

Question 9

Q12: what are spinal cord syndromes you know ?

Answer 9

Central – > Affect Motor U>L
Br-Sq Synd – > Ipsi – Motor , proprioception // Contr—pain, temp
Ant. Synd – > Bilat. Pain and temp and motor
Post. Synd – > proprioception and light touch

Question 10

Q. what to prepare after pt discharge home?

Answer 10

Neck coller brace - Facility rehabilitation – Physiotherapy – home exercise – intense spirometry 4 times daily – Leg stockings