SPINE & SPINAL CORD TRAUMA

Question 1

DDx Unstable C Spine Fractures

Answer 1

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 2

MANAGEMENT

Answer 2

INITIAL MANAGEMENT

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

1. 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
2. PHYSICAL EXAM
   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
3. BONEY LEVEL OF INJURY
4. NEUROLOGICAL LEVEL OF INJURY
   Motor Level = lowest key muscle that is 3+

Sensory Level = most caudal segment with normal sensation

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

5. ED COURSE
   Time of injury
   Time of imaging
   Time of Surgical Consultation

MONITOR COMPLICATIONS
Neurogenic Shock
Respiratory Failure