207 research outputs found
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Prehospital Evaluation and Management, Part I: Clinical Presentation, Spine Stabilization, Airway Management
No full textEach year in the United States, there are approximately 18,000 new cases of traumatic spinal cord injury (tSCI). The average age at the time of injury is 43 years and 79% of new cases occur in males. The clinical presentation can include pain, paralysis, paresthesia, loss of sensation, and loss of autonomic function below the level of injury. A detailed neurological examination, including motor and sensory testing, is essential for determining the level of injury and guiding further management. Autonomic dysfunction is a significant concern in tSCI, particularly in injuries above the T6 level. This can lead to neurogenic shock, characterized by hypotension and bradycardia due to the loss of sympathetic vascular tone. In contrast to neurogenic shock, which is a physiologic hemodynamic phenomenon, spinal shock is an immediate and temporary clinical response to acute tSCI. Spinal shock is characterized by a complete loss of motor, sensory, and autonomic functions below the level of the lesion. Prehospital spine stabilization is achieved with rigid cervical collars, spinal boards, and securing straps to prevent further injury. Acute fluid resuscitation and hemodynamic support to optimize spinal perfusion are crucial to improve clinical outcomes. Clear communication between multidisciplinary teams is required to assure a safe transition to the hospital setting. Standardized protocols and continuous education for EMS providers are necessary to ensure optimal outcomes. Patients with cervical spine injury are uniquely at risk for respiratory complications and airway compromise. Assessment and proper management of the airway are essential to diminish the risks of cervical movement in unstable fractures and preserve oxygenation and ventilation. These factors are paramount to avoid worsening secondary cord injury and improve functional recovery
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Clinical Consequences of Disrupted Feedback Control and Abnormal Circuit Reorganization After Spinal Cord Injury
No full textSpinal cord function plays a critical regulatory role in homeostasis, cardiovascular responsivity, sensation, and movement. The spinal cord houses contains connection networks that interact with the brain and brainstem, cerebellum, and peripheral nervous system. Normal function requires several levels of feedback control, filtering, and modulation. Control systems operate based on precise anatomical locations, normative set-points, functional connections, feedback regulated firing rates, and balanced excitation and inhibition. When these are altered by interruption and denervation after spinal cord injury (SCI), there may be severe consequences across the acute, subacute, and chronic phases of the injury. The magnitude and severity of disrupted feedback are generally proportional to the neurological level and completeness of injury. Well-known post-SCI problems include blood pressure (BP) dysregulation, cardiovascular dysfunction, autonomic dysreflexia (AD), neuropathic pain, spasticity, and abnormal thermal regulation. These primarily arise from deafferentation neuroplasticity and inappropriate excitation-inhibition balance. In this review, we approach these problems from the perspective of feedback disruption and illustrate how understanding the control circuits provides access points for therapies
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