Spinal cord injury resulting in neurological deficit is a rare but potentially devastating injury.
Compromise to the spinal cord may be due
- to trauma,
- vascular injury or
- other disease process and
can result in immediate or insidious onset of neurological symptoms including loss or reduction of voluntary motor function, sensory impairment, bowel or bladder dysfunction and loss of autonomic function. Appropriate management from the time of diagnosis of cord injury has been shown to have significant effect on the long-term outcome for patients and reduce short and long-term complications.
Included Patients:
All patients with traumatic spinal cord injury resulting in complete or incomplete para- or tetraplegia. The audit standards apply to those with polytrauma and those with isolated spinal cord injuries but do not apply to patients with spinal column injury without cord involvement. These audit standards apply to adults and children.
Principles
I will first approach patient based on ATLS protocol and BOAST guideline for clearing spine and also BOAST guideline for SCI
It involves
Initial evaluation
Initial management
Definitive management
Post management followup
Initial evaluation
Document ASIA chat of peripheral nervous system
Spine immobilisation on spine board
Distinguish hypovolemic shock from neurogenic shock: Bradycardia (Vascular hypotension due to ANS dysfunction of spinal cord injury)
Identify spinal shock: BC reflex (physiological spinal cord dysfunction)
Imaging based on BOAST 2 guideline, including urgent MRI