Matt Jackson is a 26 year old man who is brought to the Emergency Department after a hyperflexion injury to his neck from being dumped in the surf whilst body surfing.
He was immediately pulled from the surf by his friend.
He had immediate pain to his neck and loss of power in all limbs.
On arrival to ED, his oxygen sats are 96% on 3L NPO2, his RR is 22, HR is 60 bpm and his blood pressure is 100/60 mmHg.
In resus he is finding it difficult to breathe. His abdomen is moving up and down with respiration but his intercostal muscles aren’t moving. Would sitting him up help his breathing?
No.
Respiratory failure following traumatic cervical spinal cord injury is common and multi-factorial and is discussed in detail later on in this lesson.
Sitting patients up when they rely solely on their diaphragm for respiration, when their abdominal and intercostal muscles are paralysed, results in the diaphragm dropping to a less mechanically advantageous position and makes breathing harder.
They are best off left flat initially, with respiratory support from supplemental oxygen or intubation and ventilation if necessary.
His blood pressure is now 91/45 mmHg. Does this require intervention?
Yes.
As we’ll discuss, the cause of hypotension in acute SCI is multifactorial, with neurogenic shock and bradycardia often a main cause.
This requires exclusion of other causes of shock and treatment with judicious fluid resuscitation and often vasopressor support to prevent hypotension causing further secondary injury to his damaged spinal cord.
