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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)

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?

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Pranoy De is a new contributor to this site. Take care in asking for clarification, commenting, and answering. Check out our Code of Conduct.
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    Remember ABCDE: Airway means 'make sure it's patent'. here, the pt is breathing normally and (though not stated) probably talking. There's an adage in medicine that starts with "Treat the patient, not the [X]", where X can be numbers, chart, or something else that's worrisome. To intubate this patient next would be a case of treating your anxiety. Note that he's in a controlled setting (the hospital) if he's getting a CT scan. If his O2 sat is falling or he's having difficulty breathing, that is, when it's indicated, he'll get intubated. Commented yesterday

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Following the ATLS protocol for trauma, management of this case has reached the secondary survey stage. It begins with two procedures if not contraindicated: NG tube placement and bladder catheterization. This explains the answer to the test. Your question is noteworthy and could be a lifesaver in potential scenarios. We have never performed an intervention for prophylactic purposes; therefore, your topic is somewhat confusing. Any spinal injury above the C5 level, especially in children under 8 years old, can lead to phrenic nerve damage, diaphragm muscle malfunction, and respiratory distress as the final outcome. However, the patient's breathing is very good. He is oriented and able to talk, so there are no airway or breathing concerns. You mentioned edema in spinal cord injury, which isn't typically an issue, and adequate protection of the injured neck is enough.

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Alexi AVAX Keller is a new contributor to this site. Take care in asking for clarification, commenting, and answering. Check out our Code of Conduct.
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  • +1. One nitpick: there's nothing to suggest his breathing is compromised by an extended abdomen, or that there's a high risk of vomiting while he's restrained. I haven't taken ATLS in a while, though. I would not be comfortable placing an NG or OG tube in a patient with a probable CS fracture without an indication. Do you have access to the algorithm(s)? (I don't anymore.) Commented yesterday

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