University:
Western Sydney University
Course:
MEDI 2003 | Clinical Sciences 2
Academic year:

2024
Views:

305

Pages:

2
Author:

Mariam A.

Principles of Management of Patients with Spine or Spinal Cord Injury Spine and spinal cord injuries require prompt and careful management to prevent further damage, stabilize the injured area, and minimize neurological deficits. The management approach encompasses initial assessment, immobilization techniques, diagnostic evaluation, and definitive treatment strategies. Initial Assessment and Immobilization Techniques 1. Primary Survey (ABCDE approach): o Airway: Ensure airway patency and cervical spine protection in patients with suspected spinal injury. Use manual maneuvers (e.g., jaw thrust) to maintain alignment. o Breathing: Assess and manage ventilation to maintain oxygenation. o Circulation: Control hemorrhage and maintain hemodynamic stability. o Disability: Perform neurological assessment, including assessment of motor and sensory function, using the Glasgow Coma Scale (GCS) for overall consciousness. o Exposure: Fully expose the patient to assess for injuries, including potential spinal fractures or instability. 2. Immobilization Techniques: o Cervical Spine Immobilization: Use cervical collars and manual stabilization (e.g., inline stabilization) to prevent movement and maintain alignment during initial assessment and transport. o Spinal Board: Transfer the patient onto a spinal board with log-roll technique to minimize movement and facilitate safe transport. Diagnostic Evaluation 1. Imaging Studies: o X-rays: Initial imaging modality to assess for suspected spinal fractures or instability. o CT Scan: Provides detailed evaluation of bony structures and spinal alignment, useful for surgical planning. o MRI: Assess soft tissue injuries, spinal cord compression, or ligamentous damage, especially in non-emergent settings. 2. Neurological Assessment: o Motor and Sensory Function: Evaluate strength and sensation in all extremities to assess the level and severity of spinal cord injury. o Rectal Examination: Assess anal tone and perianal sensation to determine spinal cord integrity and potential for neurogenic bowel/bladder dysfunction. Definitive Treatment Strategies 1. Non-operative Management: o Immobilization: Continue immobilization with cervical collar, thoracolumbar brace, or halo fixation depending on the level and severity of injury. o Monitoring: Regular neurological assessments to monitor for progression or improvement in neurological deficits. 2. Surgical Intervention: o Indications: Surgical stabilization may be necessary for unstable fractures, spinal cord compression, or significant deformity. o Techniques: Include spinal fusion, decompression laminectomy, and internal fixation to stabilize the spine and prevent further neurological deterioration. Complications and Long-term Management 1. Neurological Complications: o Neurogenic Shock: Immediate cardiovascular instability due to spinal cord injury, requiring fluid resuscitation and vasopressor support. o Neurogenic Bowel and Bladder Dysfunction: Monitor and manage with bowel regimen and intermittent catheterization to prevent complications. 2. Rehabilitation and Long-term Care: o Multidisciplinary Approach: Include physical therapy, occupational therapy, and social work to facilitate recovery and improve quality of life. o Psychosocial Support: Address emotional and psychological aspects of disability and adaptation to life changes post-injury.