Embed Size (px)
Citation preview
Dr MManoranjitha kumari MChNeurosurgeon KIMS Hyderabad
CNN-2015
Spine injury and managementO-arm in spine fixation
Anatomy
Cervical Vertebrae
1048698 Small vertebral bodies1048698 less weight to carry1048698 Extensive joint surfaces1048698 greater ROM
Thoracic Vertebrae
1048698 Rib bearing vertebrae
1048698 Designed to remain stiffand straight
Lumbar Vertebrae
Weight bearingvertebrae
Spinal ligaments
Spine trauma
bull Incidence
bull In the Indian setupApproximate 20000 new cases are added every year
Mechanism
Suspect spinal injury with
1048698 Sudden decelerations (MVCs falls)
1048698 Compression injuries (diving falls onto
feetbuttocks)
1048698 Significant blunt trauma (football hockey
snowboarding jet skis)
1048698 Very violent mechanisms (explosions cave-ins
lightning strike)
1048698 Unconscious patient
1048698 Neurological deficit
1048698 Spinal tenderness
Spinal stabilization and management
1048698 Protect spine at all times in patients with multiple injuries
1048698 Up to 5 of spinal injuries have a second fracture elsewhere in the spine
1048698 whole spine should be immobilized
1Manually
2 A combination of semi-rigid cervical collar side head supports long spine board and strapping
System Oriented Approach
Airway
Breathing
Circulatory
Neurologic Classification
Spinal Imaging
Decision to Intubate
1048698 Loss of innervation of the diaphragm
1048698 Hypoventilation
1048698 VQ mismatch
1048698 Secretion retention
1048698 Associated injuries
Management of Breathing
Monitoring of SpO2 EtCO2
O2 therapy
Bronchodilators
Assisted ventilation
Positioning and mobilizing
Chest physio Assisted Cough
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Anatomy
Cervical Vertebrae
1048698 Small vertebral bodies1048698 less weight to carry1048698 Extensive joint surfaces1048698 greater ROM
Thoracic Vertebrae
1048698 Rib bearing vertebrae
1048698 Designed to remain stiffand straight
Lumbar Vertebrae
Weight bearingvertebrae
Spinal ligaments
Spine trauma
bull Incidence
bull In the Indian setupApproximate 20000 new cases are added every year
Mechanism
Suspect spinal injury with
1048698 Sudden decelerations (MVCs falls)
1048698 Compression injuries (diving falls onto
feetbuttocks)
1048698 Significant blunt trauma (football hockey
snowboarding jet skis)
1048698 Very violent mechanisms (explosions cave-ins
lightning strike)
1048698 Unconscious patient
1048698 Neurological deficit
1048698 Spinal tenderness
Spinal stabilization and management
1048698 Protect spine at all times in patients with multiple injuries
1048698 Up to 5 of spinal injuries have a second fracture elsewhere in the spine
1048698 whole spine should be immobilized
1Manually
2 A combination of semi-rigid cervical collar side head supports long spine board and strapping
System Oriented Approach
Airway
Breathing
Circulatory
Neurologic Classification
Spinal Imaging
Decision to Intubate
1048698 Loss of innervation of the diaphragm
1048698 Hypoventilation
1048698 VQ mismatch
1048698 Secretion retention
1048698 Associated injuries
Management of Breathing
Monitoring of SpO2 EtCO2
O2 therapy
Bronchodilators
Assisted ventilation
Positioning and mobilizing
Chest physio Assisted Cough
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Cervical Vertebrae
1048698 Small vertebral bodies1048698 less weight to carry1048698 Extensive joint surfaces1048698 greater ROM
Thoracic Vertebrae
1048698 Rib bearing vertebrae
1048698 Designed to remain stiffand straight
Lumbar Vertebrae
Weight bearingvertebrae
Spinal ligaments
Spine trauma
bull Incidence
bull In the Indian setupApproximate 20000 new cases are added every year
Mechanism
Suspect spinal injury with
1048698 Sudden decelerations (MVCs falls)
1048698 Compression injuries (diving falls onto
feetbuttocks)
1048698 Significant blunt trauma (football hockey
snowboarding jet skis)
1048698 Very violent mechanisms (explosions cave-ins
lightning strike)
1048698 Unconscious patient
1048698 Neurological deficit
1048698 Spinal tenderness
Spinal stabilization and management
1048698 Protect spine at all times in patients with multiple injuries
1048698 Up to 5 of spinal injuries have a second fracture elsewhere in the spine
1048698 whole spine should be immobilized
1Manually
2 A combination of semi-rigid cervical collar side head supports long spine board and strapping
System Oriented Approach
Airway
Breathing
Circulatory
Neurologic Classification
Spinal Imaging
Decision to Intubate
1048698 Loss of innervation of the diaphragm
1048698 Hypoventilation
1048698 VQ mismatch
1048698 Secretion retention
1048698 Associated injuries
Management of Breathing
Monitoring of SpO2 EtCO2
O2 therapy
Bronchodilators
Assisted ventilation
Positioning and mobilizing
Chest physio Assisted Cough
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Thoracic Vertebrae
1048698 Rib bearing vertebrae
1048698 Designed to remain stiffand straight
Lumbar Vertebrae
Weight bearingvertebrae
Spinal ligaments
Spine trauma
bull Incidence
bull In the Indian setupApproximate 20000 new cases are added every year
Mechanism
Suspect spinal injury with
1048698 Sudden decelerations (MVCs falls)
1048698 Compression injuries (diving falls onto
feetbuttocks)
1048698 Significant blunt trauma (football hockey
snowboarding jet skis)
1048698 Very violent mechanisms (explosions cave-ins
lightning strike)
1048698 Unconscious patient
1048698 Neurological deficit
1048698 Spinal tenderness
Spinal stabilization and management
1048698 Protect spine at all times in patients with multiple injuries
1048698 Up to 5 of spinal injuries have a second fracture elsewhere in the spine
1048698 whole spine should be immobilized
1Manually
2 A combination of semi-rigid cervical collar side head supports long spine board and strapping
System Oriented Approach
Airway
Breathing
Circulatory
Neurologic Classification
Spinal Imaging
Decision to Intubate
1048698 Loss of innervation of the diaphragm
1048698 Hypoventilation
1048698 VQ mismatch
1048698 Secretion retention
1048698 Associated injuries
Management of Breathing
Monitoring of SpO2 EtCO2
O2 therapy
Bronchodilators
Assisted ventilation
Positioning and mobilizing
Chest physio Assisted Cough
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Lumbar Vertebrae
Weight bearingvertebrae
Spinal ligaments
Spine trauma
bull Incidence
bull In the Indian setupApproximate 20000 new cases are added every year
Mechanism
Suspect spinal injury with
1048698 Sudden decelerations (MVCs falls)
1048698 Compression injuries (diving falls onto
feetbuttocks)
1048698 Significant blunt trauma (football hockey
snowboarding jet skis)
1048698 Very violent mechanisms (explosions cave-ins
lightning strike)
1048698 Unconscious patient
1048698 Neurological deficit
1048698 Spinal tenderness
Spinal stabilization and management
1048698 Protect spine at all times in patients with multiple injuries
1048698 Up to 5 of spinal injuries have a second fracture elsewhere in the spine
1048698 whole spine should be immobilized
1Manually
2 A combination of semi-rigid cervical collar side head supports long spine board and strapping
System Oriented Approach
Airway
Breathing
Circulatory
Neurologic Classification
Spinal Imaging
Decision to Intubate
1048698 Loss of innervation of the diaphragm
1048698 Hypoventilation
1048698 VQ mismatch
1048698 Secretion retention
1048698 Associated injuries
Management of Breathing
Monitoring of SpO2 EtCO2
O2 therapy
Bronchodilators
Assisted ventilation
Positioning and mobilizing
Chest physio Assisted Cough
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Spinal ligaments
Spine trauma
bull Incidence
bull In the Indian setupApproximate 20000 new cases are added every year
Mechanism
Suspect spinal injury with
1048698 Sudden decelerations (MVCs falls)
1048698 Compression injuries (diving falls onto
feetbuttocks)
1048698 Significant blunt trauma (football hockey
snowboarding jet skis)
1048698 Very violent mechanisms (explosions cave-ins
lightning strike)
1048698 Unconscious patient
1048698 Neurological deficit
1048698 Spinal tenderness
Spinal stabilization and management
1048698 Protect spine at all times in patients with multiple injuries
1048698 Up to 5 of spinal injuries have a second fracture elsewhere in the spine
1048698 whole spine should be immobilized
1Manually
2 A combination of semi-rigid cervical collar side head supports long spine board and strapping
System Oriented Approach
Airway
Breathing
Circulatory
Neurologic Classification
Spinal Imaging
Decision to Intubate
1048698 Loss of innervation of the diaphragm
1048698 Hypoventilation
1048698 VQ mismatch
1048698 Secretion retention
1048698 Associated injuries
Management of Breathing
Monitoring of SpO2 EtCO2
O2 therapy
Bronchodilators
Assisted ventilation
Positioning and mobilizing
Chest physio Assisted Cough
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Spine trauma
bull Incidence
bull In the Indian setupApproximate 20000 new cases are added every year
Mechanism
Suspect spinal injury with
1048698 Sudden decelerations (MVCs falls)
1048698 Compression injuries (diving falls onto
feetbuttocks)
1048698 Significant blunt trauma (football hockey
snowboarding jet skis)
1048698 Very violent mechanisms (explosions cave-ins
lightning strike)
1048698 Unconscious patient
1048698 Neurological deficit
1048698 Spinal tenderness
Spinal stabilization and management
1048698 Protect spine at all times in patients with multiple injuries
1048698 Up to 5 of spinal injuries have a second fracture elsewhere in the spine
1048698 whole spine should be immobilized
1Manually
2 A combination of semi-rigid cervical collar side head supports long spine board and strapping
System Oriented Approach
Airway
Breathing
Circulatory
Neurologic Classification
Spinal Imaging
Decision to Intubate
1048698 Loss of innervation of the diaphragm
1048698 Hypoventilation
1048698 VQ mismatch
1048698 Secretion retention
1048698 Associated injuries
Management of Breathing
Monitoring of SpO2 EtCO2
O2 therapy
Bronchodilators
Assisted ventilation
Positioning and mobilizing
Chest physio Assisted Cough
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Mechanism
Suspect spinal injury with
1048698 Sudden decelerations (MVCs falls)
1048698 Compression injuries (diving falls onto
feetbuttocks)
1048698 Significant blunt trauma (football hockey
snowboarding jet skis)
1048698 Very violent mechanisms (explosions cave-ins
lightning strike)
1048698 Unconscious patient
1048698 Neurological deficit
1048698 Spinal tenderness
Spinal stabilization and management
1048698 Protect spine at all times in patients with multiple injuries
1048698 Up to 5 of spinal injuries have a second fracture elsewhere in the spine
1048698 whole spine should be immobilized
1Manually
2 A combination of semi-rigid cervical collar side head supports long spine board and strapping
System Oriented Approach
Airway
Breathing
Circulatory
Neurologic Classification
Spinal Imaging
Decision to Intubate
1048698 Loss of innervation of the diaphragm
1048698 Hypoventilation
1048698 VQ mismatch
1048698 Secretion retention
1048698 Associated injuries
Management of Breathing
Monitoring of SpO2 EtCO2
O2 therapy
Bronchodilators
Assisted ventilation
Positioning and mobilizing
Chest physio Assisted Cough
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Suspect spinal injury with
1048698 Sudden decelerations (MVCs falls)
1048698 Compression injuries (diving falls onto
feetbuttocks)
1048698 Significant blunt trauma (football hockey
snowboarding jet skis)
1048698 Very violent mechanisms (explosions cave-ins
lightning strike)
1048698 Unconscious patient
1048698 Neurological deficit
1048698 Spinal tenderness
Spinal stabilization and management
1048698 Protect spine at all times in patients with multiple injuries
1048698 Up to 5 of spinal injuries have a second fracture elsewhere in the spine
1048698 whole spine should be immobilized
1Manually
2 A combination of semi-rigid cervical collar side head supports long spine board and strapping
System Oriented Approach
Airway
Breathing
Circulatory
Neurologic Classification
Spinal Imaging
Decision to Intubate
1048698 Loss of innervation of the diaphragm
1048698 Hypoventilation
1048698 VQ mismatch
1048698 Secretion retention
1048698 Associated injuries
Management of Breathing
Monitoring of SpO2 EtCO2
O2 therapy
Bronchodilators
Assisted ventilation
Positioning and mobilizing
Chest physio Assisted Cough
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Spinal stabilization and management
1048698 Protect spine at all times in patients with multiple injuries
1048698 Up to 5 of spinal injuries have a second fracture elsewhere in the spine
1048698 whole spine should be immobilized
1Manually
2 A combination of semi-rigid cervical collar side head supports long spine board and strapping
System Oriented Approach
Airway
Breathing
Circulatory
Neurologic Classification
Spinal Imaging
Decision to Intubate
1048698 Loss of innervation of the diaphragm
1048698 Hypoventilation
1048698 VQ mismatch
1048698 Secretion retention
1048698 Associated injuries
Management of Breathing
Monitoring of SpO2 EtCO2
O2 therapy
Bronchodilators
Assisted ventilation
Positioning and mobilizing
Chest physio Assisted Cough
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
System Oriented Approach
Airway
Breathing
Circulatory
Neurologic Classification
Spinal Imaging
Decision to Intubate
1048698 Loss of innervation of the diaphragm
1048698 Hypoventilation
1048698 VQ mismatch
1048698 Secretion retention
1048698 Associated injuries
Management of Breathing
Monitoring of SpO2 EtCO2
O2 therapy
Bronchodilators
Assisted ventilation
Positioning and mobilizing
Chest physio Assisted Cough
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Decision to Intubate
1048698 Loss of innervation of the diaphragm
1048698 Hypoventilation
1048698 VQ mismatch
1048698 Secretion retention
1048698 Associated injuries
Management of Breathing
Monitoring of SpO2 EtCO2
O2 therapy
Bronchodilators
Assisted ventilation
Positioning and mobilizing
Chest physio Assisted Cough
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Management of Breathing
Monitoring of SpO2 EtCO2
O2 therapy
Bronchodilators
Assisted ventilation
Positioning and mobilizing
Chest physio Assisted Cough
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Spinal Shock
Temporary suppression of all reflex activity below the level of injury
Occurs immediately after injury
Intensity amp duration vary with the level amp degree ofinjury
Once BCR returns spinal shock is over
Neurogenic Shock
1048698 Distributive shock
1048698 The bodyrsquos response to the sudden loss of sympathetic control
1048698 Occurs in people who have SCI above T6
(gt 50 loss of sympathetic)
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Clinical Signs of Neurogenic Shock
Clinical Triad
1048698 Hypotension
1048698 Bradycardia
1048698 Hypothermia
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Treatment
1048698 First Linebull Volume Resuscitation (1-2 L)
1048698 Second linebull Vasopressors-
counter loss of sympathetic tone
provide chronotropic support to heart
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
bull Hemodynamics and Cord Perfusion
Maintain MAP 85-90mmHg for first 7 days if possible
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Bradicardia
1048698 Avoid vagal stimulation
1048698 Hyperventilate and hyperoxygenate prior to suctioning
1048698 Pre-medicate patients with known hypersensitivity to vagal stimuli
Treatment of Symptomatic Bradycardia Atropine 05 - 10 mg IV
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
GI Intervention
bull 1048698 Minimizing Risk for Aspiration
Nasogastric tube
bull 1048698 Minimizing Risk of Gastric Ulceration
IV Ranitidine 50mg IV q8h
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Pharmacological
Pain Management
bull IASP Proposed 2 Broad Types
Musculoskeletal
Visceral
Responds well to opioids and NSAIDS
Methylprednisolone
If initiated lt 3hrs continue for 24 hrs if 3-8 hrs after injury continue for 48hrs
morbidity higher - increased sepsis and pneumonia
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Cervical traction
To realign and stabilize the spine
Fastest method of increasing the diameter of the spinal canal
Muscle relaxants and the reverse
Trendelenberg positionbull Absolute contraindications
Occipitoatlantal dislocations
Concomittant open skull fracture
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Indications for surgery
bull 1048698 Deformity correction
bull 1048698 Stabilization of the spine
bull 1048698 Decompression of neurologic elements
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
PROGNOSTIC FACTORS for
recovery
bull 1048698complete cervical injuries that remain complete within the first 24 hours of admission are unlikely to regain significant ambulatory function (1 to 3)
bull 1048698 Cervical injuries recover better than thoracic or thoracolumbar injuries
bull 1048698 Younger age groupbull 1048698 Intermedullary hemmorrhage signifies a worse
outcome
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
O arm
bull 3D navigation- of cone-beam CT enabled multiple fluoroscopic image acquisition by a device that rotated isocentrically around the patient- more accurate
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Multiplanar imaging
bull Axial sagittal and coronal images
bull Multiple level imaging without moving the machine in a single sequence
bull Imaging of the cervico dorsal junction and upper thoracic spine
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Cervico dorsal junction
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
Percutaneous fixation of D6 fracture
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
OR set up with O arm
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
O arm in spine surgery
bull 3D viewbull navigationbull Accuracy is excellentbull Less incidence of failure and second
surgerybull minimally invasive spine surgery
THANK YOU
THANK YOU
