What are the signs of SCI in unconscious patient?
- Flaccid areflexia
- Diaphragmatic breathing
- Pain response above clavicle
- Bradycardia/ hypotension
- Priapism
What is examined in potential partial/complete SCI?
- Sensory level + modality
- Motor level
- Sphincter tone
- Bulbocavernosus reflex
Define shock
Inadequate oxygen perfusion + tissue oxygenation
What can cause shock?
- Hypovolaemic = haemorrhage or fluid loss
- Tension pneumothorax
- Cardiac tamponade
- Cardiogenic
- Neurogenic
- Septic
- Anaphylatic
- Pump failure
Commonet cause = loss of blood
What is spinal shock?
- Flaccid paralysis, areflexia + lack of sensations secondary to physiologic spinal cord shut down
- Usually resolves within 24 hours
- Lowest level that can be tested = bulbocavernous reflex
- Important to determine whether complete or incomplete SCI
What is neurogenic shock?
- Reduced sympathetic outflow which = unopposed vagal tone
- Hypotension due to venous pooling
- Bradycardia = distinguishes from other types of shock
What is not recommended for SCI?
Steroids
How is spinal injury screened?
Lateral cervical x-ray
How are MRI’s used in spinal trauma?
- Exclude injury in difficult cases = ankylosing spondylitis
- Ligamentous injury
- Unexplained neurology
- Progression in neurological injury - compressions, oedema, haemorrhage, transection
What can CT’s miss in regards to SCI?
Ligamentous + disc injuries
So might still get XRs
Why is erect XR a useful adjunct after CT showing stable injury?
Development of load bearing deformity + ligament injury
What is SCIWORA?
Spinal cord injury without radiological abnormality
No fracture, ligament injury or extraneural compression
What is SCIWONA?
Spinal cord injury with neurological abnormality
Better prognosis
What are the consequences of SCI?
- Paralysed
- Inadequate ventilation
- Abnormal evaluation compromised
- Occult compartment syndrome
How is spinal injury managed?
Ventilation + oxygenation
Maintain blood pressure + spinal cord perfusion
How is hypotension managed?
In major trauma:
- haemorrhage shock until proven otherwise
- consider neurogenic shock
- monitor urine output
What is hypotensive bradycardia?
Stystolic BP 60
Bradycardia 40
What are the 3 reasons people in hypotensive bradycardia can be in shock?
Hameothorax
Ruptured aorta
Ruptured spleen
What are indications for conservative treatment?
- Stable fracture
- Some polytrauma patients
- Unfit for surgery
- Osteoporotic bones
Decompress > Realign > Stabalize
Prevent late pain/deformity
What fractures require surgery?
- Canal compromise
- Neurologic compromise
- Kyphosis/scoliosis
- Anterior collapse
- Progression
What are the complications of SCI?
- Pneumonia
- Postural hypotension
- DVT/PE
- Autonomic dysreflexia
- Renal failure
- Pseudo-obstruction
- Sexual dysfunction
- Pressure sores
What is autonomic dysreflexia?
= Condition of abnormal response of ANS following SCI
Triggered by SCI @ T6 or above
