Paediatric Spinal Injury

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

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

How do high cervical injuries and T1 injuries impact management?

Answer 10

• High cervical injuries – requires ventilation due to innervation of diaphragm and loss of intercostal muscle innervation
• T1 injuries – leads to hypotension and bradycardia due to unopposed vagal stimulation

Question 11

Secondary Spinal Cord Injury

Answer 11

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

Question 12

When can you not clear collar

Answer 12

o Age ≥ 65
o Hx bone disease
o Altered conscious state
o Intoxication
o Distracting injury
o Midline pain/tenderness on palpation of vertebrae
o Patient unable to rotate neck 45º

Question 13

SD4 Mgx

Question 14

Neurogenic Shock Pathophysiology

Answer 14

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 15

Primary and Secondary Spinal Cord Injuries

Answer 15

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.