trauama/spinal cord injury

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Question 1 / 2

683b964d31242d93219d2c4d

Emergency

trauama

spinal cord injury

Case History

A 28-year-old woman is brought to the emergency department after a severe equestrian accident, where she was found unresponsive following a fall from her horse. Paramedics reported a Glasgow Coma Scale (GCS) of 3, with initial blood pressure 75/35 mmHg and heart rate 48 bpm. Airway protection via intubation was performed at the scene. On arrival, she remains hypotensive despite the administration of 2.5 liters of crystalloid fluid en route. Her extremities are notably warm, dry, and flushed. Initial rapid trauma CT scans of the head, chest, and abdomen are unremarkable for significant active hemorrhage or other major visceral injuries. A CT angiogram of the cervical spine, however, reveals a severe C5-C6 fracture-dislocation with significant cord compression. Given these findings, what is the most likely diagnosis and the immediate definitive pharmacological management, including target parameters?

Lab Parameter	Value	Reference Range
White Blood Cell Count (WBC)	14.5 x 10^9/L	4.0-10.0 x 10^9/L
Hemoglobin (Hb)	13.2 g/dL	12.0-15.5 g/dL
Hematocrit (Hct)	39.5%	36-46%
Platelets	250 x 10^9/L	150-450 x 10^9/L
Sodium (Na)	138 mmol/L	135-145 mmol/L
Potassium (K)	4.1 mmol/L	3.5-5.0 mmol/L
Blood Urea Nitrogen (BUN)	15 mg/dL	7-20 mg/dL
Creatinine (Cr)	0.8 mg/dL	0.5-1.1 mg/dL
Glucose	110 mg/dL	70-100 mg/dL (fasting)
Lactate	1.8 mmol/L	<2.0 mmol/L

A ) Diagnosis: Acute Hemorrhagic Shock; Management: Expedite placement of large-bore IV access and initiate rapid infusion of warmed crystalloids along with activation of massive transfusion protocol.

B ) Diagnosis: Neurogenic Shock; Management: Initiate a continuous intravenous infusion of norepinephrine, titrated to maintain a mean arterial pressure (MAP) between 85-90 mmHg for the duration of spinal cord ischemia management.

C ) Diagnosis: Distributive Shock (likely septic etiology); Management: Obtain blood cultures, administer broad-spectrum antibiotics, and start a phenylephrine infusion to achieve a mean arterial pressure (MAP) of 65-70 mmHg.

D ) Diagnosis: Spinal Shock with concurrent hypovolemia; Management: Continue crystalloid boluses until euvolemia is confirmed by central venous pressure monitoring, then consider vasopressors if hypotension persists.

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Question 2 / 2

683b964d31242d93219d2c1a

Emergency

trauama

spinal cord injury

Case History

A 48-year-old female construction worker is admitted to the trauma intensive care unit after an industrial fall from scaffolding, approximately 15 feet. She was immobilized at the scene. Upon arrival, her primary complaint is an inability to move her legs and severe numbness below her chest. Physical examination reveals an alert and oriented patient with flaccid paralysis of the bilateral lower extremities, complete loss of sensation below the T4 dermatome, and absent deep tendon reflexes in the lower limbs. Her initial vital signs are: Blood Pressure 80/45 mmHg, Heart Rate 42 bpm, Respiratory Rate 16 breaths/min, Oxygen Saturation 98% on room air, Temperature 36.50C. Her skin is warm and flushed. She exhibits absent anal wink and decreased rectal tone, with no sacral sparing noted. Given these findings, what is the most likely diagnosis and what is the most appropriate immediate pharmacological intervention to stabilize her hemodynamic status?

Lab Parameter	Value	Reference Range
Hemoglobin	14.2 g/dL	12.0-15.5 g/dL
Hematocrit	42%	36-48%
White Blood Cell Count	10.5 x 10^9/L	4.5-11.0 x 10^9/L
Sodium	140 mEq/L	135-145 mEq/L
Potassium	4.1 mEq/L	3.5-5.0 mEq/L
Creatinine	0.8 mg/dL	0.6-1.2 mg/dL

A ) Acute spinal cord injury with hypovolemic shock; aggressive intravenous fluid resuscitation with crystalloids.

B ) Traumatic brain injury with Cushing's reflex; mannitol administration and urgent neurosurgical consultation.

C ) Neurogenic shock due to high spinal cord injury; judicious intravenous fluid bolus and initiation of alpha-adrenergic vasopressors like norepinephrine.

D ) Cardiogenic shock post-trauma; immediate echocardiography and inotropic support with dobutamine.

E ) Septic shock from occult injury; broad-spectrum antibiotics and source control.

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