ICU Cases · Trauma & burns
Hot case — the bedside: a suspected spinal-cord injury and neurogenic shock
A CICM hot case — a bedside encounter on a cervical-cord injury with the neurogenic shock. Tests the structured assessment (the warm, hypotensive, bradycardic picture), the immobilisation and the clearance (the Canadian C-spine rule), and the vasopressor for the vasoplegia.
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You are taken to the bedside of a 30-year-old man who dived into shallow water half an hour ago. He is immobilised on a spinal board, hypotensive at 84/52 with a heart rate of 48, warm and dry peripherally (not the cool, clammy periphery of the hypovolaemic or the cardiogenic shock), unable to move or to feel his limbs, and breathing with his diaphragm alone (a weak, paradoxical breathing). The paramedics are concerned about the low blood pressure and the slow heart rate.[1]
References3ShowHide
- [1]American College of Surgeons Committee on Trauma Advanced Trauma Life Support (ATLS) Student Course Manual. 10th edition, ACS, 2018.
- [2]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.
- [3]Stiell IG, Wells GA, Vandemheen KL, et al. The Canadian C-spine rule for radiography in alert and stable trauma patients. JAMA, 2001.PMID 11597285