Traumatic Lumbar Fracture

Question 1

Q. wht’s this chart?

Q.how to calculate pt?

Answer 1

sum Pulse + RR + Temp + BP – > 7 or 8
According to the score you’ll manage

Question 2

Q1:What scores can you use to evaluate the patient?

Answer 2

NEWS Score
GCS
Injury -severity score
Revised trauma score
Trauma injury severity score

Question 3

Q2: How to manage patient?

Answer 3

According to ATLS protocol

Question 4

Q3. Investigations?

Answer 4

Pan-CT (Trauma CT scan) and MRI for lumbosacral spine

Question 5

https://i.ibb.co/pP710hF/image.png
Q4. What is the finding in this MRI?

Answer 5

Displacement of lumbar spine with collapsed vertebrae
from a fracture with traumatic
spondylolisthesis and compression of spinal cord

Question 6

Q5.What other injuries may be associated?

Answer 6

Chest / Abdomen / Brain / Long bone injuries

Question 7

Q5.1 what other shock may this patient have?

Answer 7

Neurogenic shock (1st) – Spinal shock – Hypovolemic shock

Question 8

Q6. How will you manage circulation, what fluids will you use?

Answer 8

Large wide pore cannulas – blood sample for routine labs and for cross matching – fluid resus by 1 L of crystalloid and NorEpi and also dexa – monitor pt vital signs

Question 9

Q7: How will you monitor the progress of this patient?

Answer 9

UOP – CVP -CRT and vital signs Bp-Pulse-RR – mental status of pt

Question 10

Q8: Complications associated with spinal cord injury?

Answer 10

Early; Pain, Spasticity, Neurodegeneration, DVT
Late; Pressure ulcers, osteoporosis, contracture, incontinence.
Pressure ulcers. / Pain and spasticity. / Aut. Dysreflexia / Neurological deterioration / DVTs / Osteoporosis / Ms wasting / Incontinence and ED

Question 11

Q9. No Erectile dysfunction . Why?

Q. Reflex in spinal shock?

Answer 11

BulboCav

Question 12

ISS (Injury Severity Score)

Answer 12

• This anatomic scoring system provides an overall score for patients with multiple injuries. It is based on the
  Abbreviated Injury Scale (AIS), a standardized system of classification for the severity of individual injuries from 1
  (mild) to 6 (fatal).
• Each injury is assigned an AIS score and allocated to one of six body regions (head, face, chest, abdomen,
  extremities including pelvis, and external structures).
• The total ISS is calculated from the sum of the squares of the three worst regional values. It is important to
  emphasize that only the worst injury in each body region is used. Maximum score is 75 (52+52+52
  )
• The ISS ranges from 1 to 75, with any region scoring 6 automatically giving a score of 75
  .

Question 13

Abbreviated Injury Scale (AIS)

Answer 13

Defined Body Areas (External Structures)
Soft tissue
Head and neck
Chest
Abdomen
Extremity and/or pelvis
Face
Severity Code
Minor = 1
Moderate = 2
Severe (non–life-threatening) = 3
Severe (life-threatening) = 4
Critical (survival uncertain) = 5
Fatal (dead on arrival) = 6
NOTE: ISS = A2 + B2 + C2. A, B, and C represent three worst regional values

Question 14

RTS (Revised Trauma Score)
Sum of RR + BP + GCS

Answer 14

RTS (Revised Trauma Score)
Sum of RR + BP + GCS

Question 15

TRISS (Trauma Injury Severity Score)

Answer 15

Prognoses survival in blunt and penetrating trauma based on RTS and ISS scores.

Question 16

Hypovolaemic shock

Answer 16

Hypotension with tachycardia and cold clammy peripheries. This is most often due to haemorrhage. It should be
treated with appropriate resuscitation.

Question 17

Neurogenic shock

Answer 17

This presents with hypotension, a normal heart rate or bradycardia and warm peripheries. This is due to unopposed
vagal tone resulting from cervical spinal cord injury at or above the level of sympathetic outflow (T1/T5). It should be
treated with inotropic support, and care should be taken to avoid fluid overload.

Question 18

Spinal shock

Answer 18

Spinal shock is a temporary physiological disorganisation of spinal cord function that starts within minutes following
the injury. The length of effect is variable, but it can last 6 weeks or longer. It is characterized by paralysis, decreased
tone and hyporeflexia. Once it has resolved the bulbocavernosus reflex returns.