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Initial Management of  Spine Cord Injury  Leslie Hutchins, MD Intern Conference November 11, 2008
The frog instantly dies when the spinal cord is pierced; and before this it lived without head, without heart or any bones or intestines or skin, and here therefore it would seem lies the foundation of movement and life.  All the nerves of the animals derive from here: when this is pricked they instantly die.   -Leonardo da Vinci.  Lifshutz J. Colohan A.  A brief history of therapy for traumatic spinal cord injury.   Neurosurg Focus.  2004 Jan 15;16(1):E5.
Edwin Smith Surgical Papyrus  (2500 BC) ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Lifshutz J. Colohan A.  A brief history of therapy for traumatic spinal cord injury.   Neurosurg Focus.  2004 Jan 15;16(1):E5.
Hippocrates  (5 th -4 th  Century BC) ,[object Object],[object Object],[object Object],[object Object],[object Object],Lifshutz J. Colohan A.  A brief history of therapy for traumatic spinal cord injury.   Neurosurg Focus.  2004 Jan 15;16(1):E5.
Galen   (150 BC) ,[object Object],[object Object],Lifshutz J. Colohan A.  A brief history of therapy for traumatic spinal cord injury.   Neurosurg Focus.  2004 Jan 15;16(1):E5.
World War I ,[object Object],[object Object],Lifshutz J. Colohan A.  A brief history of therapy for traumatic spinal cord injury.   Neurosurg Focus.  2004 Jan 15;16(1):E5.
14,000 Spinal Cord Injuries in  North America per year Lifshutz J. Colohan A.  A brief history of therapy for traumatic spinal cord injury.   Neurosurg Focus.  2004 Jan 15;16(1):E5.
Level of Injury ,[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Spinal Cord Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Spinal Cord Anatomy ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Incomplete Lesion ,[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
 
 
 
Signs of Incomplete Lesion ,[object Object],[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Types of Incomplete Lesions: ,[object Object],[object Object],[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Complete Lesion ,[object Object],[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Spinal Shock ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Spinal Shock ,[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Treated for SCI until proven otherwise: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Initial Management of  Spine Cord Injury ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Stabilization &  Initial Evaluation ,[object Object],[object Object],[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Immobilization Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713. http://www.itim.nsw.gov.au/go/clinical-resources/spinal-injuries/guidelines-on-spinal-injuries/spinal-log-roll-guide
Hypotension ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Maintenance  ,[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Spinal Cord Anatomy: Vasculature  ,[object Object],[object Object],[object Object],[object Object]
Spinal Cord Anatomy: Vasculature  ,[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],Spinal Cord Anatomy: Vasculature
Spinal Cord Anatomy: Vasculature ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Spinal Cord Anatomy: Vasculature  ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Initial Class III Study of BP Management in SCI ,[object Object],[object Object],[object Object],[object Object],Zach GA, Seiler W, Dollfus P: Treatment results of spinal cord injuries in the Swiss Paraplegic Centre of Basel.  Paraplegia  14: 58-65, 1976.
Frankel Grade Function        A               complete paralysis     B               sensory function only below the injury level     C               incomplete motor function below injury level     D               fair to good motor function below injury level     E               normal function
Outcome ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Zach GA, Seiler W, Dollfus P: Treatment results of spinal cord injuries in the Swiss Paraplegic Centre of Basel.  Paraplegia  14: 58-65, 1976.
[object Object],[object Object],[object Object],[object Object],Class III Study of BP Management in SCI Levi L, Wolf A, Belzberg H: Hemodynamic parameters in patients with acute cervical cord trauma: Description, intervention, and prediction of outcome.  Neurosurgery  33:1007-1017, 1993.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Levi L, Wolf A, Belzberg H: Hemodynamic parameters in patients with acute cervical cord trauma: Description, intervention, and prediction of outcome.  Neurosurgery  33:1007-1017, 1993. Outcomes
[object Object],[object Object],[object Object],[object Object],Class III Study of BP Management in SCI Vale FL, Burns J, Jackson AB, Hadley MN: Combined medical and surgical treatment after acute spinal cord injury: Results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management.  J Neurosurg  87: 239-246, 1997.
Outcomes ,[object Object],Vale FL, Burns J, Jackson AB, Hadley MN: Combined medical and surgical treatment after acute spinal cord injury: Results of a prospective pilot study to assess the merits of aggressive medical resuscitation and blood pressure management.  J Neurosurg  87: 239-246, 1997.
Oxygenation ,[object Object],[object Object],[object Object],[object Object],[object Object],Ledsome JR, Sharp JM: Pulmonary function in acute cervical cord injury.  Am Rev Respir Dis  124: 41-44, 1981.
 
 
Stomach ,[object Object],[object Object],[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Bladder ,[object Object],[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
DVT Prophylaxis ,[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Temperature Regulation ,[object Object],[object Object]
 
 
 
Electrolytes ,[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Detailed Neurological Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
[object Object],Detailed Neurological Examination Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713. http://www.itim.nsw.gov.au/go/clinical-resources/spinal-injuries/guidelines-on-spinal-injuries/spinal-log-roll-guide
[object Object],[object Object],[object Object],Detailed Neurological Examination Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Motor impairment related to Spinal Cord Injury
[object Object],[object Object],[object Object],[object Object],[object Object],Detailed Neurological Examination Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Dermatomes
Detailed Neurological Examination ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Detailed Neurological Examination ,[object Object],[object Object],[object Object],[object Object],Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
Radiographic Assessment of the Cervical Spine in the Asymptomatic Trauma Patient ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Radiographic assessment of the cervical spine in asymptomatic trauma patients. Neurosurgery. 2002 Mar;50(3 Suppl):S30-5. Review.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Hoffman JR, Mower WR, Wolfson AB, Todd KH, Zucker MI: Validity of a set of clinical criteria to rule out injury to the cervical spine in patients with blunt trauma: National Emergency X-Radiograph Utilizatio nStudy Group.  N Engl J Med  343:94-99, 2000. Radiographic Assessment of the Cervical Spine in the Asymptomatic Trauma Patient
[object Object],[object Object],Radiographic Assessment of the Cervical Spine in the Asymptomatic Trauma Patient Radiographic assessment of the cervical spine in asymptomatic trauma patients. Neurosurgery. 2002 Mar;50(3 Suppl):S30-5. Review.
Radiographic Assessment of the Cervical Spine in Symptomatic Trauma Patients ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery. 2002 Mar;50(3 Suppl):S30-5. Review.
Radiographic Assessment of the Cervical Spine in Symptomatic Trauma Patients ,[object Object],[object Object],[object Object],[object Object],Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery. 2002 Mar;50(3 Suppl):S30-5. Review.
Radiographic Assessment of the Cervical Spine in Symptomatic Trauma Patients ,[object Object],[object Object],[object Object],[object Object],Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery. 2002 Mar;50(3 Suppl):S30-5. Review.
Radiographic Assessment of the Cervical Spine in Symptomatic Trauma Patients ,[object Object],[object Object],[object Object],[object Object],Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery. 2002 Mar;50(3 Suppl):S30-5. Review.
Radiographic Assessment of the Cervical Spine in Symptomatic Trauma Patients ,[object Object],[object Object],[object Object],[object Object],Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery. 2002 Mar;50(3 Suppl):S30-5. Review.
Radiographic Assessment of the Cervical Spine in Symptomatic Trauma Patients ,[object Object],[object Object],[object Object],Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery. 2002 Mar;50(3 Suppl):S30-5. Review.
Radiographic Assessment of the Cervical Spine in Symptomatic Trauma Patients ,[object Object],[object Object],[object Object],Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery. 2002 Mar;50(3 Suppl):S30-5. Review.
Radiographic Assessment of the Cervical Spine in Symptomatic Trauma Patients ,[object Object],Radiographic assessment of the cervical spine in symptomatic trauma patients. Neurosurgery. 2002 Mar;50(3 Suppl):S30-5. Review.
Medical Management Specific to Spinal Cord Injury ,[object Object],[object Object],Pharmacological Therapy after Acute Cervical Spinal Cord Injury. Neurosurgery. 2002 Mar;50(3 Suppl):S30-5. Review. Greenberg, M.  Handbook of Neurosurgery: Sixth Edition . 2006; 698-713.
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Medical Management Specific to Spinal Cord Injury
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Initial Management Of Sci

  • 1. Initial Management of Spine Cord Injury Leslie Hutchins, MD Intern Conference November 11, 2008
  • 2. The frog instantly dies when the spinal cord is pierced; and before this it lived without head, without heart or any bones or intestines or skin, and here therefore it would seem lies the foundation of movement and life. All the nerves of the animals derive from here: when this is pricked they instantly die. -Leonardo da Vinci. Lifshutz J. Colohan A. A brief history of therapy for traumatic spinal cord injury. Neurosurg Focus. 2004 Jan 15;16(1):E5.
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  • 7. 14,000 Spinal Cord Injuries in North America per year Lifshutz J. Colohan A. A brief history of therapy for traumatic spinal cord injury. Neurosurg Focus. 2004 Jan 15;16(1):E5.
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  • 23. Immobilization Greenberg, M. Handbook of Neurosurgery: Sixth Edition . 2006; 698-713. http://www.itim.nsw.gov.au/go/clinical-resources/spinal-injuries/guidelines-on-spinal-injuries/spinal-log-roll-guide
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  • 32. Frankel Grade Function     A               complete paralysis     B               sensory function only below the injury level     C               incomplete motor function below injury level     D               fair to good motor function below injury level     E               normal function
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  • 52. Motor impairment related to Spinal Cord Injury
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