Paed SCI

Question 1

Prophylactic Antiemetic and Doses

Answer 1

Ondansetron
4-8mg Oral/IV (A)
Paediatrics Small Child 2mg, Medium Child 4mg ORAL

Question 2

Neurovascular Assessment

Answer 2

Colour
Temp
Sensation
Movement
Cap Refill
Pulse
Swelling

Question 3

Ondans Indications

Answer 3

Undifferentiated nausea and vomiting
Prophylaxis where vomiting could be clinically detrimental (e.g. spinally immobilised,
penetrating eye trauma)

Question 4

Ondans Contras

Answer 4

Apomorphine (see Significant Interactions)

Question 5

Ondans Precautions

Answer 5

Pregnancy 1st trimester – consult with receiving hospital
Congenital Long QT syndrome – ondansetron causes QT prolongation (dose-dependent effect)
and increases the risk of Torsades de pointes in patients with a prolonged QT interval (QTC >
500 ms). Unlikely when administered at approved doses but avoid if patient has a history of
congenital Long QT syndrome.
1
Severe hepatic disease (e.g. cirrhosis) – limit total daily dose to a maximum of 8 mg (all routes
of administration)
Ondansetron ODT may contain aspartame which should be avoided in patients with
phenylketonuria. Ondansetron injection can be administered if appropriate

Question 6

Ondans Side Effects

Answer 6

CNS: Headache, dizziness
CV: QT prolongation (rare)
GI: Constipation
Other: Visual disturbance, including transient loss of vision (rare, associated with rapid IV
administration)

Question 7

Cervical Collar Indications

Answer 7

Indications as per SCI
- major trauma criteria after blunt trauma to head/trunk
- neurological deficits or changes

Question 8

Cervical Collar Contras

Answer 8

• Surgical Airway
• Penetrating Neck Trauma
• Unable to achieve neutral position

Question 9

Neurogenic Shock Pathophysiology

Answer 9

Neurogenic shock is the result of autonomic dysregulation following spinal cord injury, usually secondary to trauma. This dysregulation is due to a loss of sympathetic tone and an unopposed parasympathetic response.

Question 10

Primary and Secondary Spinal Cord Injuries

Answer 10

Primary spinal cord injury occurs within minutes of the initial insult. Primary injury is direct damage to the axons and neural membranes in the intermediolateral nucleus, lateral grey mater, and anterior root that lead to disrupted sympathetic tone. Secondary spinal cord injury occurs hours to days after the initial insult. Secondary injury results from vascular insult, electrolyte shifts, and edema that lead to progressive central hemorrhagic necrosis of grey matter at the injury site.