Spinal Cord Injuries Part 2: ED and Early Care-Handout: Spinal Cord Injuries Part 2

Handout: Spinal Cord Injuries Part 2

Pdf Summary

The document provides comprehensive educational material on early emergency department (ED) care and procedures for spinal cord injuries, crafted by Robert D. Greenberg, MD, FACEP, and Gay L. Kurtz, MSN, RN, CNL, CEN, under the auspices of the Trauma Center Association of America (TCAA). Accredited by the Accreditation Council for Continuing Medical Education (ACCME), the session offers a maximum of 1.00 AMA PRA Category 1 Credit™ for physicians and 1.0 contact hours for nurses approved by the California Board of Registered Nursing.<br /><br />The key learning objectives include the following:<br />- Identifying initial nursing roles during EMS report or patient presentation.<br />- Performing detailed physical and neurological examinations.<br />- Understanding the use and indications for Spinal Motion Restriction (SMR) protocols.<br />- Choosing appropriate imaging and diagnostic tests.<br />- Recognizing the necessity for an early neurosurgical consult.<br />- Differentiating various incomplete cord syndromes.<br />- Preparing for early patient care and resuscitation in the ED.<br />- Managing care for hypotensive patients.<br />- Planning early patient disposition.<br /><br />The document underscores the importance of a systematic initial assessment exploring ABCs (Airway, Breathing, Circulation) and neurologic status (D). Hypoxia, bleeding, and CNS indicators (motor, reflex, sensation discrepancies) are especially emphasized. Detailed neurologic assessments span cervical, thoracic, lumbar, and sacral spines, examining aspects like pain, tenderness, and specific motor-sensory innervations.<br /><br />Imaging guidelines recommended CT as the first-line investigation tool, with MRI for suspected spinal cord injuries or compression. Limitations of plain radiography and conditions such as SCIWORA (Spinal Cord Injury Without Radiographic Abnormality) are explained.<br /><br />Central, anterior, and Brown-Sequard syndromes among spinal cord injuries are discussed in terms of symptoms and implications. For instance, anterior cord syndrome notes bilateral loss of pain and temperature sensation with retained tactile sense.<br /><br />The document details continuous monitoring protocols, vital signs, and neurological symptom evaluations, alongside management of shock types. The importance of timely neurosurgical intervention for decompression and stabilization is highlighted.<br /><br />Overall, this education addresses both theoretical and practical approaches to initial care in spinal cord trauma, recommending a methodical diagnosis, treatment, and patient transfer to a facility with specialized capabilities.

Keywords

spinal cord injuries

emergency department care

initial assessment

neurologic examinations

Spinal Motion Restriction

imaging guidelines

neurosurgical consult

shock management

patient resuscitation

Trauma Center Association of America