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Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of...
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Transcript of Waleed Awwad, MD, FRCSC. Introduction Multiple injuries. Brain injury. Spinal injury. Area of...
Introduction• Multiple injuries.• Brain injury.• Spinal injury.• Area of injury.• 5% of patent with neurological
symptom.• Excluding the presence of spinal
injury.
• Multiple injuries.• Brain injury.• Spinal injury.• Area of injury.• 5% of patent with neurological
symptom.• Excluding the presence of spinal
injury.
Anatomy• Spinal Cord
• Complete spinal cord injury.
• Incomplete spinal cord injury.
• Sacral sparing.
• Neurogenic shock Vs Spinal shock
• Spinal Cord
• Complete spinal cord injury.
• Incomplete spinal cord injury.
• Sacral sparing.
• Neurogenic shock Vs Spinal shock
AnatomySensory Examination C5 over deltoid
C6 Thumb C7 Middle finger C8 Little finger T4 Nipple T8 Xiphisternum T10 Umbilicus T12 Symphysis pubis L4 medial aspect of calf L5 Web space 1st & 2nd toe S1 Lateral border of the foot S4-5 Perianal region
Sensory Examination C5 over deltoid
C6 Thumb C7 Middle finger C8 Little finger T4 Nipple T8 Xiphisternum T10 Umbilicus T12 Symphysis pubis L4 medial aspect of calf L5 Web space 1st & 2nd toe S1 Lateral border of the foot S4-5 Perianal region
Anatomy• Myotomes
C5 Deltoid C6 wrist extensors C7 Elbow extensors C8 finger flexors T1 Small finger abductor L2 Hip flexors L3-4 Knee extensors L 4,5 S1 Knee flexion L5 Ankle and big toe dorsiflextion S1 Ankle planter flexors
• Myotomes
C5 Deltoid C6 wrist extensors C7 Elbow extensors C8 finger flexors T1 Small finger abductor L2 Hip flexors L3-4 Knee extensors L 4,5 S1 Knee flexion L5 Ankle and big toe dorsiflextion S1 Ankle planter flexors
Classification Level
Neurologic level.
Sensory level.
Motor level.
T1 level
Level
Neurologic level.
Sensory level.
Motor level.
T1 level
Of spinalCord injury
Classification Severity of neurologic deficit
Complete
Incomplete
? Any sensation ? Sacral spairing
Severity of neurologic deficit
Complete
Incomplete
? Any sensation ? Sacral spairing
Of spinalCord injury
Classification Spinal cord Syndromes
Central cord syndrom.
Anterior cord syndrom.
Brown-Sequard’s Syndrom.
Spinal cord Syndromes
Central cord syndrom.
Anterior cord syndrom.
Brown-Sequard’s Syndrom.
Of spinalCord injury
Classification Central Cord Syndrom
# Characterized by disproportionally.
# Mechanism: # Occure with or without… # Recovery… # Prognosis… # Due to…
Central Cord Syndrom
# Characterized by disproportionally.
# Mechanism: # Occure with or without… # Recovery… # Prognosis… # Due to…
Of spinalCord injury
Classification Anterior Cord Syndrom
# Characterized..
# Posterior column Function
# Due to…
# Prognosis…
Anterior Cord Syndrom
# Characterized..
# Posterior column Function
# Due to…
# Prognosis…
Of spinalCord injury
Classification Brown-Sequard’s Syndrome # Occurance..
# Due to…
# Characteristic…
Brown-Sequard’s Syndrome # Occurance..
# Due to…
# Characteristic…
Of spinalCord injury
Classification Morphology
# Fractures.
# Fracture dislocations.
# SCIWORA.
# Penetrating Injury.
# Blunt trauma.
Morphology
# Fractures.
# Fracture dislocations.
# SCIWORA.
# Penetrating Injury.
# Blunt trauma.
Of spinalCord injury
Specific types Atlanto-occipital dislocation. Atlas fracture. Axis fractures: Odontoid fracture. Posterior element fracture of C2.
Fractures and dislocations ( C3-C7 ). Thoracic spine fractures. Thoracolumber junction fractures. Lumbar fractures.
Specific types Atlanto-occipital dislocation.
# Uncommon.
# Sever flexion and Distraction.
# Prognosis…
# Shaken baby syndrom.
# Traction??
Atlanto-occipital dislocation.
# Uncommon.
# Sever flexion and Distraction.
# Prognosis…
# Shaken baby syndrom.
# Traction??
management IV Fluids. Medications. Vasopressors: Phynylephrine, Dopamine
or NE Steroids:
> Within .. > First 3hrs… > Between 3-8hrs….
IV Fluids. Medications. Vasopressors: Phynylephrine, Dopamine
or NE Steroids:
> Within .. > First 3hrs… > Between 3-8hrs….