Chapter 23- Spinal Cord Injury

Question 1

If cord injury is a possibility what is the treatment at the scene of the accident

Answer 1

• move ‘en bloc’
• restore neck gently to a neutral position
• immobilize head: sandbags, cervical collar, halter
• adequate restraint in ambulance
• transport to nearest hospital for primary care

Question 2

When should you have a high index of suspicion for cord injury

Answer 2

• unconscious patients
• Significant head injury
• falls from height
• major facial fractures
• cases of near drowning

Local features: pain, deformity, Stab wound near the spine

Distal features: neurological deficit

General:

• unexplained shock
• unexplained respiratory difficulty
• unexplained retention of urine
• beware of retention and overflow
• priapism

Question 3

What types of incomplete lesions are there?

Answer 3

Sharp trauma: brown-sequard syndrome

Blunt trauma: central cord syndrome

Question 4

How do you assess sacral segments

Answer 4

• test peri-anal and perineal sensation
• do rectal exam:
  Feel anal tone
  Voluntary sphincter control
  Rectal sensation
  Bulbocavernosus reflex

Question 5

Treatment of cord injury

Answer 5

• respiratory support
• cardiovascular support
• gastro intestinal suppor
• urinary support
• integument support
• medication
• psychological support

Transfer to spinal injury center