Spinal Cord Injury

BETA VERSION JUST NOTES

RSI is felt to be safe with in line stabilization acutely but succinylcholine is contraindicated from 72 hrs to 6 months post-injury because of life threatening hyperkalaemia. Acute denervation causes acetylcholine receptors to spread beyond the motor end plate of the neuromuscular junction, increasing receptor exposure to succinylcholine (1,2).

C-spine movement should be minimized during laryngoscopy, especially flexion, which is thought to be more dangerous to the cord than extension (1).

Do not sit patients up with acute high-thoracic SCI as they will have better respiratory function lying flat. The diaphragm has a greater excursion in inspiration as it is pushed into the chest by abdominal contents; if sitting, the diaphragm is pulled down by abdominal contents impeding further excursion in inspiration (1).

Patients must be ‘log rolled’ off the board, ideally within 30 min after arrival in hospital. The spinal board is a transport device only and its prolonged use is associated with pressure sores (1).

Neurogenic shock is common in T2-5 injuries, resulting in a decrease in SVR, decreased inotropism, and increased vagal tone. Intermittent atropine may be required, especially before vagally stimulating procedures (e.g. laryngoscopy or tracheal suctioning) (1-3).

Early catheterization is essential to avoid bladder overdistension that may precipitate bradycardia. Consider supra pubic catheterization if priapism is present (1,3).
References:
(1) Bonner S, et al. Contin Educ Anaesth Crit Care Pain 2013;13: 224-231.
(2) Dooney N, et al. Int J Crit Illn Inj Sci 2011; 1: 36-43.
(3) Lo v, et al. J Neurosurg Sci 201357:281-92.

Central Cord Syndrome
The signature features of this syndrome include symmetric weakness affecting the upper extremities more than the lower extremities, spasticity, and occasionally bowel and bladder dysfunction (JEM, epub, 12/17/14).

Why do unstable spine injuries in the mid-thoracic region lead to a high chance of complete cord injury but injuries in the upper cervical area, particularly in the region of C1/2, often do not produce associated cord injury?
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The Answer is:

The spinal canal contains the spinal cord in a potential space filled with epidural fat and blood vessels. This space is narrowest in the mid-thoracic region but the upper cervical area has more space around the cord (Con Educ Anaesth Crit,V.13:224)

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