Trauma (Spinal Injury)

Question 1

What is considered a significant MOI for potential SCI

Answer 1

• Any injury with potential for hyper-flexion, hyper-extension, hyper-rotation or axial loading of the spinal column
  
  • high force (MVA rollover/ejection, per vs car, diving accident)

Question 2

Which elderly patients should we have high suspicion for SCI?

Answer 2

• those with vertebral disease or precious spinal abnormalities
• (Ankylosing spondylitis, spinal fusion, previous c spine injury and RA)
  
  • may sustain SCI from far less force (e.g. fall from standing height)

Question 3

Do you routinely immobilise a penetrating trauma?

Answer 3

No, consider immobilisation where there is demonstrable neurological deficit

Question 4

Recite the Spinal Injury CPG

Answer 4

Question 5

Recite the Spinal Injury - Neurological Exam CPG

Answer 5

Question 6

What does the phrenic nerve control and what injuries affect it?

Answer 6

• Controls the diaphragm
• C3, 4 and 5

Question 7

what are some spinal signs and symptoms?

Answer 7

• hypotension - due to venous pooling and decreased venous return
• bradycardia - due to unopposed parasympathetic response
• paralysis - damage to motor nerves
• priaprism - neurological and vascular causes
• paradoxical resps - loss of innervation to the thoracic musculature
• paraesthesia - damage to sensory nerves

Question 8

What is the treatment if you have a suspected SCI or major trauma?

Answer 8

• apply C spine collar
• extricate on combi carrier if required
• immobilise on vacuum mattress on stretcher
  
  • transfer without delay as per the trauma critical guideline

Question 9

What is the treatment for an isolated SCI?

Answer 9

• if BP <90
• NaCl 10mls/kg

Question 10

Why do we give limited fluid is SCI patients?

Answer 10

• cautious fluid management is necessary to avoid fluid overload and oedema

Question 11

Why do patients with spinal shock have hypotension and bradycardia?

Answer 11

• Hypotension → due to venous pooling and decreased venous return
• Bradycardia → due to unopposed parasympathetic response

Question 12

Why would you only given 10mls/kg of NaCl?

Answer 12

• to see if it corrects the hypotension. SCI patients are not dehydrated, all there fluids are still there. it is pooling in the peripheries

Question 13

What is in the Modified nexus criteria?

Answer 13

• age > 65
• hx of bone of muscle weakening disease/injury
• altered conscious state
• intoxication
• significant distracting injury
• midline pain/tenderness
• pt unable to rotate neck 45 degrees left and right without pain

Question 14

When can the patient protect their own spine/self extricate?

Answer 14

• conscious
• cooperative
• not intoxicated
• not prevented by other injuries

Question 15

How many of the modified nexus criteria points do you need to be cleared?

Answer 15

0

Question 16

How many points of the modified nexus criteria points do you need to initiate spinal precautions?

Answer 16

1