Coda Change Acute Spinal Cord Injury: What Matters
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Jul 29, 2021 Olly Flower, co-founder of SMAC and a clinician-educator specializing in acute spinal cord injury, dives into critical care strategies for traumatic cervical spinal cord injuries. He explains the nuances of the ISNCSCI exam and its prognostic value. Olly emphasizes the importance of preventing hypoxia and the complexities of airway management. He discusses blood pressure targets, particularly aiming for a MAP over 85 mmHg, and the urgency around surgical timing, advocating for intervention within eight hours for better outcomes.
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Do A Standardised Neurological Exam Early
- Use the ISNCSCI/ASIA exam early to standardise neurological assessment and prognostication.
- Document motor/sensory levels and sacral sparing before sedation to inform teams and family.
Act Early To Prevent Hypoxia
- Avoid hypoxia aggressively in acute cervical spinal cord injury because secondary neurological damage is possible.
- Consider awake fibre-optic intubation when feasible and use inline stabilisation, video laryngoscope and bougie if immediate intubation is required.
Diaphragm Becomes The Single Respiratory Engine
- Cervical injuries often leave the diaphragm as the primary working respiratory muscle via C3-4-5.
- Lying flat can improve mechanics because paralysed abdominal muscles let contents drop and worsen diaphragmatic disadvantage when upright.