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Pranoy De
Pranoy De
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I stumbled across a question in emergency medicine which goes as follows:

"A 20-year-old hockey player is brought to the emergency department 30 minutes after falling headfirst into the hockey rink boards. He did not lose consciousness during the impact but was unable to move his arms and legs afterward. The patient was placed in a rigid cervical collar and transported to the hospital on a backboard; 2 large-bore intravenous catheters were inserted en route. On arrival, blood pressure is 128/78 mm Hg, pulse is 102/min, and respirations are 14/min. The patient is alert and appears anxious. Cardiopulmonary examination is normal. Neurologic examination shows intact cranial nerves. Pinprick and temperature sensation are absent below the level of the clavicles; vibratory sense is intact. The patient is still unable to move his extremities. CT scan of the cervical spine reveals a burst fracture of C5 with impingement of posteriorly displaced fragments on the spinal cord. Neurosurgery is consulted. Which of the following is the best next step in management of this patient?"

A. Orotracheal intubation
B. Bladder catherisation
C. (other options)
<br

Now the answer was bladder catherisation. And the explanation was that it's because the autonomic fibres in the spinal cord can get affected. My question is- isn't there a possibility of progressive spinal edema, worsening impingement and extension of hemorrhage (in case there is one) which may lead to rapid deterioration of the diaphragm (c5-7) and intercostal muscles (T1-11) and subsequent respiratory arrest which thereby warrants a prophylactic intubation?

I stumbled across a question in emergency medicine which goes as follows:

"A 20-year-old hockey player is brought to the emergency department 30 minutes after falling headfirst into the hockey rink boards. He did not lose consciousness during the impact but was unable to move his arms and legs afterward. The patient was placed in a rigid cervical collar and transported to the hospital on a backboard; 2 large-bore intravenous catheters were inserted en route. On arrival, blood pressure is 128/78 mm Hg, pulse is 102/min, and respirations are 14/min. The patient is alert and appears anxious. Cardiopulmonary examination is normal. Neurologic examination shows intact cranial nerves. Pinprick and temperature sensation are absent below the level of the clavicles; vibratory sense is intact. The patient is still unable to move his extremities. CT scan of the cervical spine reveals a burst fracture of C5 with impingement of posteriorly displaced fragments on the spinal cord. Neurosurgery is consulted. Which of the following is the best next step in management of this patient?"

A. Orotracheal intubation
B. Bladder catherisation
C. (other options)
<br

Now the answer was bladder catherisation. And the explanation was that it's because the autonomic fibres in the spinal cord can get affected. My question is- isn't there a possibility of progressive spinal edema, worsening impingement and extension of hemorrhage (in case there is one) which may lead to rapid deterioration of the diaphragm (c5-7) and intercostal muscles (T1-11) and subsequent respiratory arrest which thereby warrants a prophylactic intubation?

I stumbled across a question in emergency medicine which goes as follows:

"A 20-year-old hockey player is brought to the emergency department 30 minutes after falling headfirst into the hockey rink boards. He did not lose consciousness during the impact but was unable to move his arms and legs afterward. The patient was placed in a rigid cervical collar and transported to the hospital on a backboard; 2 large-bore intravenous catheters were inserted en route. On arrival, blood pressure is 128/78 mm Hg, pulse is 102/min, and respirations are 14/min. The patient is alert and appears anxious. Cardiopulmonary examination is normal. Neurologic examination shows intact cranial nerves. Pinprick and temperature sensation are absent below the level of the clavicles; vibratory sense is intact. The patient is still unable to move his extremities. CT scan of the cervical spine reveals a burst fracture of C5 with impingement of posteriorly displaced fragments on the spinal cord. Neurosurgery is consulted. Which of the following is the best next step in management of this patient?"

A. Orotracheal intubation
B. Bladder catherisation
C. (other options)

Now the answer was bladder catherisation. And the explanation was that it's because the autonomic fibres in the spinal cord can get affected. My question is- isn't there a possibility of progressive spinal edema, worsening impingement and extension of hemorrhage (in case there is one) which may lead to rapid deterioration of the diaphragm (c5-7) and intercostal muscles (T1-11) and subsequent respiratory arrest which thereby warrants a prophylactic intubation?

Source Link
Pranoy De
Pranoy De
  • 123
  • 4

Prophylactic intubation in cases of spinal cord trauma?

I stumbled across a question in emergency medicine which goes as follows:

"A 20-year-old hockey player is brought to the emergency department 30 minutes after falling headfirst into the hockey rink boards. He did not lose consciousness during the impact but was unable to move his arms and legs afterward. The patient was placed in a rigid cervical collar and transported to the hospital on a backboard; 2 large-bore intravenous catheters were inserted en route. On arrival, blood pressure is 128/78 mm Hg, pulse is 102/min, and respirations are 14/min. The patient is alert and appears anxious. Cardiopulmonary examination is normal. Neurologic examination shows intact cranial nerves. Pinprick and temperature sensation are absent below the level of the clavicles; vibratory sense is intact. The patient is still unable to move his extremities. CT scan of the cervical spine reveals a burst fracture of C5 with impingement of posteriorly displaced fragments on the spinal cord. Neurosurgery is consulted. Which of the following is the best next step in management of this patient?"

A. Orotracheal intubation
B. Bladder catherisation
C. (other options)
<br

Now the answer was bladder catherisation. And the explanation was that it's because the autonomic fibres in the spinal cord can get affected. My question is- isn't there a possibility of progressive spinal edema, worsening impingement and extension of hemorrhage (in case there is one) which may lead to rapid deterioration of the diaphragm (c5-7) and intercostal muscles (T1-11) and subsequent respiratory arrest which thereby warrants a prophylactic intubation?