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Spinal Trauma: Pre-Hospital Management (Assessment (Perianal (Normal…
Spinal Trauma: Pre-Hospital Management
Classification
Potential spinal trauma
Mechanism is suspicious
No neurological signs or symptoms
Actual spinal trauma
Confirmed neurological signs
Neurogenic shock
Results from disruption of the sympathetic chain
Bradycardia and hypotension
Vasodilation and heat loss
May be present
without
any motor or sensory signs
Treatment Goals
Minimise secondary injury
Avoid hypotension
Avoid hypoxia
Avoid movement BUT remember than hypoxia and hypotension are more injurious than movement
Manage neurogenic shock
Active warming: vasodilated patient loses heat
Vasopressors
Beware bradycardia - have atropine drawn
Fluid bolus
Catheterise
Avoid urinary retention
Monitor organ perfusion
Assessment
Motor
Lowest level with 3/5 power (movement against gravity)
Sensory
Lowest level with
normal
sensation
Priapism
Perianal
Normal sensation?
Normal tone?
Neurogenic shock?
Intubation
Indiations
Absolute
Unsafe airway
Ventilatory inadequacy
Relative
Humanitarian
Long transport time
Risks
Hypoxia peri-induction
Mitigate: pre-O2, BVM in apnoeic period
Hypotension peri-induction
Mitigate: metaraminol
Movement
MILS doesn't prevent movement, and worsens view
Patient won't protect their neck