Why do spinal injured patients die? Diagnostic dilemmas Management errors Misunderstanding spinal cord injuries Why do things go wrong ? Long term problems.

Slides:



Advertisements
Similar presentations
Non-invasive Ventilation
Advertisements

Spine Injury LAMRT Nov 08. Spinal cord injuries ● All patients with multiple trauma should be suspected of having a spinal injury ● Failure to detect.
Mechanical Ventilation in Special Conditions
LESSON 16 BLEEDING AND SHOCK.
Educational Resources
Spinal Cord Disorder Michael H. Wilhelm, CRNA, APRN.
General Principles of Postoperative Care The mortality of elective surgery of pulmonary and esophageal resection remains 2 to 4 times than that of elective.
Mechanical Ventilatior
Weaning in Spinal Cord Injury ICS 12/2007. Epidemiology, Demographics and Pathophysiology of Acute Spinal Cord Injury. Lali H.S. et al SPINE 26;245; s2-s12.
PHYSIOTHERAPY ADJUNCTS Billie Hurst Part-Time Lecturer QMUC.
Recognition and management of the seriously ill child Dr Esyld Watson Consultant in Adult and Paediatric Emergency Medicine.
Respiratory disease main cause of death in Spinal Cord Injury.
Sepsis.
Airway obstruction Trauma foreign bodies inflammation hematomas CNS disease secretions Drug overdose Infections glottitis Obstructive sleep apnea.
Chest trauma. 70 % deaths in road traffic accidents are due to thoracic trauma Traumas can be penetrating or blunt.
بسم الله الرحمن الرحیم. NEAR-DROWNING DROWNING :submersion injuries that result in death in less than 24 h. NEAR-DROWNING : survival longer than 24 h.
Biphasic cuirass ventilation Identification BCVWhy?Who?How?Where?When?
J. Prince Neelankavil, M.D.
Mechanical Ventilation Tariq Alzahrani M.D Assistant Professor College of Medicine King Saud University.
Respiratory Failure Esam H. Alhamad, M.D Assistant Professor of Medicine Consultant Pulmonary and Critical Care Medicine.
Objectives Discuss the principles of monitoring the respiratory system
Cardiac Arrhythmia. Cardiac Arrhythmia Definition: The pumping action of the heart is coordinated by an electrical system within the heart tissue.
Positive Pressure Ventilation: The Basics Pramita Kuruvilla, M.D. Critical Care Course June 2009.
Pathophysiology of Respiratory Failure Fern White & Annabel Fothergill.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 6 Advanced Respiratory Care Skills.
Respiratory Therapy! Just breathe!.
Shock Amr Mohsen.
Asthma Management Introduction, Anatomy and Physiology University of Utah Center for Emergency Programs and The Utah Asthma Program.
Ventilator Weaning with Spinal Cord Injury & Tracheostomy.
University of California, San Francisco
DR MUHAMMAD BILAL NON INVASIVE VENTILATION. DEFINITION : - DELIVERY OF MECHANICAL VENTILATION TO THE LUNGS THAT DON’T REQUIRE ET.T. OR TRACHEOSTOMY IRON.
Chapter 32 Shock Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
SHOCK BASIC TRAUMA COURSE SHOCK IS A CONDITION WHICH RESULTS FROM INADEQUATE ORGAN PERFUSION AND TISSUE OXYGENATION.
Page  2  Introduction  Physiological Aspects  Monitoring Requirements.
Introduction to Critical Care
Shock Presented by Dr Azza Serry. Learning objectives  Definition  Pathophysiology  Types of shock  Stages of shock  Clinical presentation  management.
Eugene Yevstratov MD. Sustained Ventricular Tachycardia No pulse Pulse present UnstableStable O 2 and IV access Treat as VF Lidocaine 1mg/kg Consider.
1 Geriatric Trauma Gram McGregor, 1Lt, WA ANG Critical Care Air Transport Nurse.
Chapter 22 Pneumothorax CL GA DD
Shock Basic Trauma Course Shock is a condition which results from inadequate organ perfusion and tissue oxygenation.
The airway in obese patients
ZARIA THORACIC CLUB MEETING AHMADU BELLO UNIVERSITY TEACHING HOSPITAL,ZARIA,NIGERIA TRACHEAL INJURIES DR SANNI R. O 25 th
Exercise 40 Respiratory Physiology 1. Processes of respiration Pulmonary ventilation External respiration Transport of respiratory gases Internal respiration.
Post Resuscitation Care. To understand: The need for continued resuscitation after return of spontaneous circulation How to treat the post cardiac arrest.
PAEDIATRIC TRAUMA. Learning outcomes Approach to patient Approach to patient Differences compared to adult trauma Differences compared to adult trauma.
Thoracic Trauma Chapter 4.
Chapter 24 Vital Signs.
SHOCK. SHOCK Shock is a critical condition that results from inadequate tissue delivery of O2 and nutrients to meet tissue metabolic demand. Shock does.
20-Feb-16Respiratory failure1 Pathophysiology of Respiratory Failure.
Copyright © 2006 by Mosby, Inc. Slide 1 PART IX Diffuse Alveolar Disease.
A&E(VINAYAKA) MECHANICAL VENTILATION IN ARDS / ALI Dr. V.P.Chandrasekaran,
Complex Respiratory Disorders N464- Fall Ventilator-Associated Pneumonia (VAP) Aspiration of bacteria from oropharynx or gastrointestinal tract.
ROLE OF PT IN ICU. Goals of PT in ICU 1.Improve / maintain normal or baseline ventilation and oxygenation 2.Improve / maintain musculoskeletal system.
Copyright © 2006 by Mosby, Inc. Slide 1 Chapter 44 Postoperative Atelectasis Figure Alveoli in postoperative atelectasis. A, Total alveolar collapse.
Respiratory Problems - 1
Nadeeka Jayasinghe Week 06. Discuss treatment modalities for:  Tracheostomy care  Metered dose inhalers  Artificial airway management  Deep breathing,
Artificial Respiration
An Introduction to Intensive Care Medicine
University of California, San Francisco
Post-resuscitation care
SHOCK.
Management of Pulmonary Conditions
Objectives Describe the cardiovascular monitoring techniques used in the care of critically ill patients and how to interpret the results of hemodynamic.
4th year anaesthesia tutorial MBChB
Pulmonary Embolism Doug Bretzing, pgy 3
You could ventilate a patient
Acute Spinal Cord Injury
Respiratory Physiology
Chapter 25 Respiratory Care Modalities
5 Introduction to Pathophysiology.
Presentation transcript:

Why do spinal injured patients die? Diagnostic dilemmas Management errors Misunderstanding spinal cord injuries Why do things go wrong ? Long term problems arise from shortsightedness

Incidence 20/million population per year RTA Motorbike car pedestrian cyclist Falls jumped pushed Sports Diving horseriding rugby Infections Tumours Discs Iatrogenic

SCIWORA

Spinal Cord Injury Without Radiographic Abnormality

Neuronal dysfunction/ death Direct trauma Haematoma Ischaemia Hypotension Hypoxia Oedema Pathophysiology of spinal cord injury

Cardiorespiratory physiology

Respiratory Afferents Intrapulmonary receptorsVagus Stretch/proprioreceptors ribs/intercostalsT1-T12 ClaviclesLow Cervical ChemoreceptorsCarotid body ChemoreceptorsBrainstem

Respiratory dysfunction LumbarUnable to cough Low thoracic  chest wall compliance  Vital capacity High thoracic  chest wall compliance  Vital capacity poor expansion. Basal collapse C5/C6Diaphragms and accessory only C3/C4/C5Accessory only Above C3Very little

Respiratory autonomic dysfunction Bronchial hypersecretion Bronchial hyper-responsiveness

Respiratory monitoring Lung functionFVC, PEFR, Speech, RR FVC> 1L FVC < 1L FVC= Tidal volume Pulse oximeter Blood gasses Watch closely in an appropriate environment for several days

Respiratory treatment Oxygen A good physiotherapist NIPPB (Birding) Non-invasive ventilation Invasive ventilation Tracheostomy

Respiratory treatment What if they do get ventilated ? Weaning is likely to be slow and difficult Wait until pulmonary compliance is normal and chest is clear Extubate onto noninvasive bipap

How to intubate? Emergency or elective? Awake or sedated or asleep? Suxamethonium?

Acute cardiovascular changes Vasodilation  Vasoconstriction T4-T6 Hypotension Loss of cardiac sympathetics Bradycardia

Acute cardiovascular changes Be carefull….. Postural hypotension Vagal stimulation (tracheal suction) Pressure sores

Cardiovascular management Judicious fluid management CVP monitoring PA catheter Oesophageal doppler Inotropes Chronotropes Temporary pacing Why Bother ?

NASCIS III Methylprednisolone 30mg/Kg over 15 minutes wait 45 minutes 5.4 mg/Kg/Hr for 23 hours if >4 hours post injury 5.4 mg/Kg/Hr for 47 hours if >4 but <8 hours

Feedback: Privacy Policy Feedback
Do Not Sell My Personal Information
About project: SlidePlayer Terms of Service

© 2025 SlidePlayer.com. Inc. All rights reserved.