Prolonged Field Care Podcast 204: Spinal Trauma

In this episode of the PFC Podcast, Dennis and JP Kolcun, a neurosurgery resident, delve into the complexities of spinal trauma. They discuss the differences between spinal shock and neurogenic shock, the assessment and management of penetrating and blunt spinal injuries, and the critical importance of addressing secondary injuries. The conversation emphasizes the need for timely intervention and the nuances of trauma care in both field and hospital settings. This conversation delves into the complexities of spinal cord injury treatment, emphasizing the importance of timely surgical decompression, understanding spinal cord perfusion, and the role of intrathecal pressure. The discussion highlights the need for optimizing spinal cord perfusion pressure and the implications of using vasopressors. Innovations in treatment, including the potential for intrathecal medication delivery and advancements in brain-computer interfaces, are explored as future avenues for improving patient outcomes.

Takeaways

• Spinal shock is a neurologic phenomenon, while neurogenic shock is hemodynamic.
• Penetrating spinal cord injuries are often more severe than blunt injuries.
• Immediate stabilization and ABCs are crucial in trauma care.
• Understanding the difference between spinal shock and spinal cord injury is vital.
• Secondary injury can worsen outcomes if not addressed promptly.
• Timely decompression of the spinal cord can improve recovery chances.
• Assessment of spinal stability is essential in blunt trauma cases.
• The presence of a bulbocavernous reflex can indicate spinal cord injury.
• Norepinephrine is preferred for treating neurogenic shock.
• Avoid hypotension to prevent further complications in spinal injuries. The timing of surgical decompression can significantly impact recovery.
• Surgical decisions must consider the overall health of the patient, not just the injury.
• Spinal cord perfusion is critical for recovery post-injury.
• Intrathecal pressure varies and can affect spinal cord perfusion.
• Targeting spinal cord perfusion pressure may improve outcomes over traditional MAP goals.
• Vasopressors can constrict blood vessels, potentially reducing perfusion to the spinal cord.
• Innovative treatments, such as lumbar drains, can enhance spinal cord perfusion.
• Research is ongoing into the use of intrathecal medications for spinal cord injury.
• The ultimate goal is to improve quality of life for spinal cord injury patients.
• Advancements in technology may lead to breakthroughs in treating chronic spinal cord injuries.

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