SPINE - NON TRAUMA + TRAUMA
SPINAL INJURY INTUBATION
PromptList complications and management of cervical cord injury (Non neuro things)
ResponseRespiratory failure – intubate/ventilate
Hypotention - Fluids/Inotropes
Urinary retention – insert IDC
Hypothermia – forced warm air / external warming
Aspiration – insert NGT, drain stomach
Pressure areas – spinal bed/Air Mattress, nursing cares/rolling
Seek and treat other spinal injury
Hypotention - Fluids/Inotropes
Urinary retention – insert IDC
Hypothermia – forced warm air / external warming
Aspiration – insert NGT, drain stomach
Pressure areas – spinal bed/Air Mattress, nursing cares/rolling
Seek and treat other spinal injury
PromptList indications for intubation and supporting features on assessment
Response
Cord injury higher than C6
Cord injury higher than C6
PromptList modifications to RSI in spinal trauma
ResponsePreload with fluid prior to induction to prevent hypotension (eg N/saline 500mL bolus) and prepare push dose pressors (eg Metaraminol, Ephedrine) to maintain MAP >70
Pretreat with Atropine 600mcg to minimise bradycardia with intubationInductions drugs to ensure haemodynamic stability (eg Ketamine 102mg/kg)
Use of Video laryngoscope to minimise neck movements during intubation
Anticipate difficult view on laryngoscopy and prepare adjuncts such as bougie, VL
Consider awake fibreoptic intubation in theatre if necessary resources & expertise available
Maintain manual inline stabilisation during intubation to minimise neck movement
N.B Suxamethonium is not contraindicated in first 72 hrs after spinal injury so no mark given for this answer
Pretreat with Atropine 600mcg to minimise bradycardia with intubationInductions drugs to ensure haemodynamic stability (eg Ketamine 102mg/kg)
Use of Video laryngoscope to minimise neck movements during intubation
Anticipate difficult view on laryngoscopy and prepare adjuncts such as bougie, VL
Consider awake fibreoptic intubation in theatre if necessary resources & expertise available
Maintain manual inline stabilisation during intubation to minimise neck movement
N.B Suxamethonium is not contraindicated in first 72 hrs after spinal injury so no mark given for this answer