Protocol Detail
SPINAL CORD INJURY
Emergency signs and symptoms of a spinal cord injury after an accident may include: Extreme back pain or pressure in your neck, head or back. Weakness, incoordination or paralysis in any part of your body. Numbness, tingling or loss of sensation in your hands, fingers, feet or toes. Loss of bladder or bowel control.
Diagnosis
Diagnosis usually obvious from history, Mechanism Of Injury & clinically BUT have a high index of suspicion or will miss it.
Pain at the fracture site may not be a severe.
Level of injury is determined by the highest fully intact myotone & dermatome level. Any function below this implies a partial injury that has a more favorable outcome.
Reflexes tend to be absent at first.
Don’t forget to test the anal sensation & tone/contraction.
Beware of Spinal Cord injury without radiological abnormality (SCIWRA) especially in children- requires MRI after normal CT
Management
1. Immobilization in supine position.
2. Control mobility with strapping & hard cervical collar +/- intubation with rapid sequence induction & ventilation,
3. ABC’s (spinal injury commonly associated with airway obstruction & hypoventilation),
4. Resuscitation as indicated,
5. Intubation & ventilation if respiratory compromise – with & Atropine prior to suction/ intubation (prevents further bradycardia), NOT use Suxamethonium as can precipitate sudden hyperkalaemia & cardiac arrest.
6. IV acces (large bore canula)
7. FBC, U&E’s, LFT’s, Group an Retain cross-match as indicated,
8. Nasogastrict tube & keep NPO
9. Cathetrise patient
10. Cervical Spine X-Rays/ CT, Supine CXR,
11. IV fluids to maintain Systolic BP at 80 mmHg or above. Low Systolic BP with tachycardia is NOT due solely to spinal shock). Beware of over infusion.
12. Bradycardia needs correction with Atropine 0.5-1.0mg if HR <50 bpm,
13. Consider use of ionotropes if abdequate perfusion pressure cannot be maintained or produce urine after hypovolaemia is corrected,
14. Carefully & closely monitor body temperature,
15. Steroids are not generally recommended but use if advised to do so,
16. Immobilize & DON’T attempt to reduce fractures. Only consider application of skeletal traction & reduce on direct advise of the Medical Officer.
17. Arrange for expedient transfer (Decompression should preferably occur within 8 hours if possible & needed).
Recent Protocols
COVID 19
COVID 19 is a disease caused by the most recently discovered coronavirus which is a large family of corona viruses causing illnesses. In humans it causes Respiratory infections for example Severe Acute Respiratory Disease (SARs) PRESENTATION Fever 77-98% Cough 46-82% Myalgia/Fatigue 11-52% Shortness of breath 3-31% Incubation period 14 days, most people develop symptoms between 5-6ays from exposure Stage1 (Early infection). Stage 2. Stage 3(Hyperinflation phase) Viral response---------------------------Pulmonary Phase----------------------Host Response *Anyone presenting with flu like symptoms should be assumed to be a COVID 19 case until proven otherwise*
WARFARIN OVERDOSE/ TOXICITY
Overdose of the oral anticoagulant warfarin (Coumadin), or drug interactions with warfarin, can lead to toxicity. Similarly, toxicity can result from exposure to superwarfarins, which are long-acting anticoagulants used in rodenticides. ... Warfarin is the most common oral anticoagulant in current use
SUICIDAL IDEATION
Suicidal ideation, also known as suicidal thoughts, is thinking about or having an unusual preoccupation with suicide.
SNAKE ENVENOMATION
snake envenomation causes headache, a thick feeling of the tongue, thirst, sweating and vomiting
SEROTONIN SYNDROME
Serotonin syndrome (SS) is a group of symptoms that may occur following use of certain serotonergic medications or drugs. The degree of symptoms can range from mild to severe. Symptoms include high body temperature, agitation, increased reflexes, tremor, sweating, dilated pupils, and diarrhea.
