SPINE & SPINAL CORD TRAUMA

Question 1

Complications of Spinal Cord Injuries

Answer 1

Neurogenic Shock
Respiratory Failure

Question 2

Documentation of Spinal Cord Injuries

Answer 2

Level: Bony level injury, Neurological level of injury - most caudal segment of the spinal cord that has normal sensory and motor function (>/ 3+) on both sides

Severity of Neurologic Deficit: incomplete vs. complete paraplegia or quadriplegia

Question 3

Documentation of Spinal Cord Injuries

Answer 3

Boney level of injury
Neurological Level of Injury
Motor Level = lowest key muscle that is 3+
Sensory Level = most caudal segment with normal sensation

Question 4

Documentation of Spinal Cord Injuries: Level

Answer 4

Boney level of injury
Neurological Level of Injury
Motor Level = lowest key muscle that is 3+
Sensory Level = most caudal segment with normal sensation

Question 5

DDx Unstable C Spine Fractures

Answer 5

Jefferson Bit Off A Hangman’s Thumb

Jefferson Burst Fracture
Bilateral Facet Dislocation
Odontoid Type II & III
Atlanto Occipital Dissociation
Hangman’s Fracture
Teardrop Fracture

Question 6

MANAGEMENT

Answer 6

Initiate early intubation for complete spinal cord injuries at C5 and above.
ketamine 1-2 mg/kg intravenously.
Oxygen PRN - Avoid Hypoxia
Target MAP 85-90 mm HG
Treat with volume resuscitation and norepinephrine as a continuous infusion at 0.05-1 μg/kg/minute intravenously, and titrate to effect 0.02 μg/kg/minute every 5 minutes.

Replace Emergency C-Spine Collar with More comfortable collar
Remove patient from backboard
Spinal Immobilization
Keep patient level
DOCUMENTATION

PHYSICAL EXAM
ATLS General Approach
Identify Distracting injuries that may make spinal clearance impossible
Log Roll
Assess Spine for bruising, bogginess, tenderness, deformity
Assess rectal tone and rectal sensation
Complete Neurological Exam
HISTORY
Mechanism of injury
Restraints and airbag deployment
Ambulation at scene
Change in neurological examination from time of injury to ED
Complaints of neck or back pain
Use of steroids
History of spinal fractures

DDx: Unstable C Spine Fractures
Jefferson Burst Fracture
Bilateral Facet Dislocation
Odontoid Type II & III
Atlanto Occipital Dissociation
Hangman’s Fracture
Teardrop Fracture

Consult Spinal Surgery for unstable fracture

DOCUMENT
Time of injury
Time of imaging
Time of Surgical Consultation

SPINAL CORD INJURY:
Level: Bony level injury, Neurological level of injury - most caudal segment of the spinal cord that has normal sensory and motor function (>/ 3+) on both sides
Severity of Neurologic Deficit: incomplete vs. complete paraplegia or quadriplegia