Emergency Neurological Life Support: Traumatic Spine Injury

Abstract

Traumatic spine injuries (TSIs) carry significantly high risks of morbidity, mortality, and exorbitant health care costs from associated medical needs following injury. For these reasons, TSI was chosen as an ENLS protocol. This article offers a comprehensive review on the management of spinal column injuries using the best available evidence. Though the review focuses primarily on cervical spinal column injuries, thoracolumbar injuries are briefly discussed as well. The initial emergency department (ED) clinical evaluation of possible spinal fractures and cord injuries, along with the definitive early management of confirmed injuries, are also covered.

Spinal Cord Transection in a Type II Odontoid Fracture From a Ground-Level Fall

“…The patient's hypotension was likely due to neurogenic shock from the high spinal cord injury further exacerbating her anoxic brain injury. Neurogenic shock can be seen in spinal cord injuries above T6 and is characterized by hypotension, bradycardia and autonomic dysfunction [12]. Hypotension occurs as the result of the loss of systemic vascular resistance from the loss of sympathetic tone, leading to vasodilation from unopposed parasympathetic responses [12].…”

“…Neurogenic shock can be seen in spinal cord injuries above T6 and is characterized by hypotension, bradycardia and autonomic dysfunction [12]. Hypotension occurs as the result of the loss of systemic vascular resistance from the loss of sympathetic tone, leading to vasodilation from unopposed parasympathetic responses [12]. Flexion force may result in airway edema, resulting in airway obstruction [13].…”

Radiological Assessment Of Cervical Spine Mobility Comparing Direct Laryngoscopy With Miller Blade And Video-Laryngoscopy With CMAC In Healthy Adults

“…This shows an advantage regarding this device when compared to the standard method of OTI, which is especially useful in patients with cervical pathology. A reduction in the range of cervical spine motion during OTI in patient with cervical pathology is critical as it reduces the risk of causing or worsening a spinal cord injury at that level [3].…”

“…A reduction in CS movement during OTI is beneficial for these patients because undesirable mobilization can create or worsen a neurological injury [2]. Moreover, patients with cervical instability and acute cardiovascular or airway compromise may require a rapid intubation which should be made in the fewest attempts possible while minimizing cervical mobilization (CM) as much as possible [3]. Patients with other spinal cord diseases also benefit from a reduction in CS motion during direct laryngoscopy (DL), because this decreases the possibility of nerve and vascular structure compression due to vertebral displacement.…”

Graphene-Based Scaffolds for Regenerative Medicine

“…Because of the inability of central neurons to regenerate, traumatic brain injury, and spinal cord injury have profound adverse effects on life quality and are a significant cause of mortality [264]. Efforts from the scientific community to address this issue resulted in several pharmacological and surgical therapeutic strategies [265].…”