Unanticipated Quadraplegia in an Unconscious Mechanically Ventilated Traumatic Head Injured Patient

Abstract

ObjectiveCase Report Conclusion Key Words:A significant number of unconscious patients who present to the emergency department as a result of Road Traffic Accident (RTA) or fall have a major injury to the Cervical Spine. This case highlights the problems of identification of such injuries in the unconscious.An unconscious young adult was admitted from the accident and emergency into the intensive care unit with a clinical impression of traumatic head injury. Neck collar was applied and the airway secured with an orotracheal tube. Following positive pressure ventilation for about ten minutes, the patient suddenly woke up to full consciousness and started shaking his head violently and uncontrollably, necessitating his tracheal extubation. He then complained of his inability to use or feel his limbs. Radiological investigation revealed complete dislocation of first (C ) and second (C ) cervical vertebra; a crack in the left temporal skull and a contused left lung. He was re-intubated about 20 minutes later when his respiratory efforts began to weaken, and ventilated under propofol sedation. He gradually became ventilator dependent, with collapse of cardiovascular and respiratory systems and died on thirteenth day of admission.Cervical Spine injury should be suspected in all unconscious patients following trauma.Cervical Spine Injury, Quadriplegia, Mechanical Ventilation.1 2 against unseen obstacle during a fast forward movement as was the case in our patient. Radiological evaluation of the upper cervical spine following such severe trauma is usually difficult but fractures occur in this part of the vertebra much more than ordinary cross- Case Presentation