SPINAL CORD INJURY

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Spinal Cord Injury
Damage to the
spinal cord

Levels of the
spine
Spinal Cord Injury 3
“The higher the spinal level injury,
the greater the degree of injury.”
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SPINAL CORD COMPRESSION
Disorder of sensory and motor
dysfunction caused by direct
pressure or compromised
vascular supply to the spinal
cord
Medical emergency!
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SPINAL SEGMENTS NERVE SUPPLY
CERVICAL C4- DIAPHRAGM
C5- DELTOID AND BICEPS
C6- WRIST
C7- TRICEPS
C8- HAND

THORACIC T2-T7 – CHEST MUSCLES

T9-T12 – ABD MUCLES

LUMBAR L1-L5 – LEG MUSCLES

SACRAL S2-S5 – BLADDER,BOWEL,

SEXUAL FXNS
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At-Risk Population:
 Spinal degenerative diseases
 Malignant bone metastasis MS
 Osteoporosis
 Cervical sprain
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Mehanism of Injury
 HYPERFLEXION / FLEXION INJURY
 Cervical Flexion Injury
 Lower Thoracic Lumbar
 HYPEREXTENSION INJURY
 AXIAL LOADING/ VERTICAL COMPRESS
INJURY
 PENETRATING INJURY
 LOW VELOCITY
 HIGH VELOCITY
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CENTRAL CORD SYNDROME
BROWN-SEQUARD
SYNDROME
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DX:
 X-ray
 CT
 MRI

Immobilization
Stabilization
Monitor ABC
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S/Sx:
 Back pain – 1st and most common
 Gradual, progressive, unrelenting,
aggravated by manual palpation
 Paresthesia
 Numbness
 Coldness in the affected area
 Autonomic dysfuntion – bowel and
bladder difficulties
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Mgt:
 Treat the cause
 Radiation therapy
 Surgical decompression
 Resection of the tumor
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MEDS:
Pamidronate (Aredia) and
zoledronate  biphosphonates,
decreases bone demineralization.
Dexamethasone (Decadron)
 Atropine (Bradycardia)
 Dopamine (inotropin, for
hypotension)
 Methylprednisolone (steroid)
ACUTE HEMORRHAGE RELATED TO 13
GUNSHOT WOUND
 Leading cause of high-velocity
penetrating trauma.
 The amount of destruction is
directly related to the:
 caliber of the gun
 type of bullet
 proximity of the muzzle to the
victim
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Terminologies
 Entrance wound (inlet velocity) (V1) –
maximal point of energy
 Exit wound (outlet velocity) (V2) –
velocity at which the bullet exits the body.
 Retardation – the resistance the bullet
meets as it passes through tissues.
 Yawing – bullets travel in a slightly upward
and downward motion as they push
forward.
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Important points:
 Dense tissues have the tendency to
take up more energy resulting in
greater damage
 Handguns shoot a single bullet that
contains powder encased in metal
 Shotguns are metal encasements
containing multiple smaller pellets
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S/Sx and Mgt:
 Same as HYPOVOLEMIC SHOCK
 ABC
 Optimize breathing
 Establish intravascular access
 2 IV access with large bore
needle
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S/Sx and Mgt:
 Replace intravascular volume
Crystalloid (750-1500 bld loss)
Blood product (>1500 bld loss)
Fluid should be warmed
Rapid infusing pump
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S/Sx and Mgt:
 Manage bleeding
 Apply direct pressure
 Pneumatic Anti Shock Garment (PASG)
or Medical Anti Shock Trousers (MAST)
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Indications
Treatment of hypotension
Stabilize lower extremity or
pelvic fracture
Control bleeding under the
device