INFORMATION
secondary neurogenic shock due to spinal
29-year old journalist
was racing on an empty road when a car
from the left was about to crash him
lost control and hit the side of the street
when trying to avoid the car
one of the passers-by asked the others not
can't feel his arms or legs
to move him
the ambulance arrived in few minutes
was unconsious, but had detectable pulse
they tried to invert the patient to remove
the helmet, but tried to maintain his head
and neck in place
regains counsious in the ambulance, but
couldn't identify the time, person, and
place
was insoected by orthopedist when he first
bradycardia
arrived at the hospital
swimmer's view radiography was done
the dr suggested careful use of
anticoagulants
nasogastric tube is inserted
intravenous fluid are started through
jugular vein
surgery will not help
Pain is controlled with low dose of
morphine
SYMPTOMS
unconsious, but can breath
unable to identify the time, person, and
place
can't move his digits
severe pain in the neck, extending to both
shoulders, and radiating to both hands
limited upper limbs movement, due to the
pain
bilateral flaccid paralysis of the lower
limbs
abscent feet senseations
peripheral vasodilation
low blood pressure
ivans fractures are still not recovered after limbs are warm, no apex dislocation, no
6 weeks of hospitalization
PE, LAB RES, INVESTIGATIONS
full neurological assessment was perfored
oriented in time, place and person
responds to command but cant move his
legs
no head or face injuries
no injuries of the chest, arms nor legs
No jaundice, anaemia, cyanosis, or
edema
no clubbing of the fingers
pulse: 54 bpm
supine pressure 90/70 mmHg
armpit temp: 35.8 ºC
breathing frequency 24/min;
noise,
normal heart tones
trachea is in the midline, bilateral
reduction of excursion,
normal tactile vocal fremitus, percussion
and symmetric breathing sounds.
no obvious painful abdomen, no palpable
mass, bowel sounds are heard.
normal rectal examination, no anal nor
bulbocavernous reflexes
Speech is clear and significant, Good
understanding of the conversation.
Pupils are equal,
Corneal reflex, jaw and swallowing are
not affected
Sky and uvula rise symmetrically.
proprioception is present in the fingers but
not in the thighs nor shanck
unstable fracture at C7
no signs of abdominal
trauma,
the other symptoms where caused by
neurogenic
shock.
HYPOTHESIS LOB's
normal control of the motor system.
cord injury
fractured spinal cord (at the level of cervix) structure and function of the stretch reflex
spinal shock anatomy and physiology
anatomy and function of components of the
CNS related to sensation
how and why sensory pathways are
topographically organised, and the
distorted scale.
define pain and distinguish between
nociception and pain;
types of pain
acute pain following traumatic
injury pathways
‘referred pain’, including a brief explanation
of the underlying
mechanisms.
neurogenic shock
structure and function of the autonomic
nervous system.
neurological control of bladder function
concussion and confusion.
features of post-traumatic stress disorder.
first aid of suspected head and spinal injury
in the unconscious trauma victim.
primary management of a casualty with
spinal trauma in A&E.
perform a peripheral nerve examination,
concentrating on the motor aspects of the
examination.
patients history about neurological
symptoms.
how to treat this patients case
communication skills required in the
assessment and management of patients
with chronic pain.
role of the physiotherapist in neuro-
rehabilitation.