Neurogenic shock management
Consider intubation injuries at C5 or above
Manual in-line stabilization reduces cervical movement better than C-collar, but be careful of tracheal pressures inadvertently applied which can worsen laryngeal visualization
Direct laryngoscopy causes C-spine extension at atlanto-occipital junction, C1-C2, and C4-C7 in order from most to least
Consider video laryngoscopy with hyperangulated stylet or bougie assisted DL to intubate higher-grade laryngoscopy views of vocal cords without C-spine overextension
Post-intubation sedation takes into consideration hemodynamics and potential intraoperative EMG and evoked potential monitoring by anesthesia
Opioids do not impact evoked potential monitoring
Ketamine may enhance evoked potential monitoring
Consider dexmedetomidine as a Propofol sparing medication in TIVA
Consider surgical intervention for:
Progressive neurologic deficits
Unstable spine fractures
Steroids are no longer recommended
Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is NOT approved by the FDA for this indication. There is no Class I or Class II medical evidence supporting the clinical benefit of MP in the treatment of acute SCI. Scattered reports of Class III evidence claim inconsistent effects likely related to random chance or selection bias. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death.
See EBQ:High Dose Steroids in Cord Injury for further discussion
Manual in-line stabilization reduces cervical movement better than C-collar, but be careful of tracheal pressures inadvertently applied which can worsen laryngeal visualization
Direct laryngoscopy causes C-spine extension at atlanto-occipital junction, C1-C2, and C4-C7 in order from most to least
Consider video laryngoscopy with hyperangulated stylet or bougie assisted DL to intubate higher-grade laryngoscopy views of vocal cords without C-spine overextension
Post-intubation sedation takes into consideration hemodynamics and potential intraoperative EMG and evoked potential monitoring by anesthesia
Opioids do not impact evoked potential monitoring
Ketamine may enhance evoked potential monitoring
Consider dexmedetomidine as a Propofol sparing medication in TIVA
Opioids do not impact evoked potential monitoring
Ketamine may enhance evoked potential monitoring
Consider dexmedetomidine as a Propofol sparing medication in TIVA
Progressive neurologic deficits
Unstable spine fractures
Administration of methylprednisolone (MP) for the treatment of acute spinal cord injury (SCI) is not recommended. Clinicians considering MP therapy should bear in mind that the drug is NOT approved by the FDA for this indication. There is no Class I or Class II medical evidence supporting the clinical benefit of MP in the treatment of acute SCI. Scattered reports of Class III evidence claim inconsistent effects likely related to random chance or selection bias. However, Class I, II, and III evidence exists that high-dose steroids are associated with harmful side effects including death.
See EBQ:High Dose Steroids in Cord Injury for further discussion
Good
Brown-Séquard syndrome
Complete spinal cord transection syndrome
Conus medullaris syndrome
Anterior cord syndrome
Lateral medullary syndrome
Central cord syndrome
Epidural compression syndromes
Cauda equina syndrome