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Acute Spinal Cord Injuries: A Surgeon’s Perspective
Lesson 1: Introduction to Acute Spinal Cord Injuries
Aetiology of SCI:
4 Topics
Motor vehicle accidents (MVA)
Sports injuries
Diving accidents
Gunshot wounds (GSWs)
Epidemiology
3 Topics
Higher incidence in males (4:1 male to female ratio)
Common in older patients (>75 years) due to falls
Mortality rate of 17% upon initial admission
Socio-economic Impact
1 Topic
|
1 Quiz
The significant costs associated with SCI care, with treatment costs in the USA reaching 4 billion dollars annually
What is the most common cause of SCI in patients older than 75 years?
Lesson 2: Pathophysiology of Spinal Cord Injury
Mechanical Injury
1 Topic
Direct tissue disruption and motion stresses leading to cord oedema, necrosis, and haemorrhage.
Biochemical Injury
2 Topics
Release of lysosomes and hydrolases, leading to lipid peroxidation and breakdown of neuromembranes within 6-8 hours.
Role of corticosteroids in reducing oedema and stabilizing membranes.
Haemodynamic Injury
1 Topic
Effects on blood flow and oxygen tension, especially during the first 3-4 hours after injury.
Lesson 3: Acute Management of SCI
Initial Evaluation
2 Topics
History (mode of injury, time since injury, etc.)
Examination (BP, pulse, local tissue disruption, and neurological assessment)
Neurological Grading
2 Topics
Frankel Grading System (A-E)
ASIA (American Spinal Injury Association) Scores
Case Study
1 Topic
Present a case of a trauma patient with suspected SCI. Ask learners to perform a neurological assessment and assign a Frankel Grade.
Lesson 4: Management Strategies in SCI
Mechanical Decompression
1 Topic
Indirect (reduction of dislocation) vs. Direct (surgical decompression requiring expertise and imaging)
Blood Pressure Management
1 Topic
The importance of maintaining mean arterial pressure (MAP) to ensure spinal cord perfusion.
Respiratory Support
1 Topic
Ventilation for high cervical injuries and managing complications related to diaphragmatic breathing.
Pressure Sore Prevention
1 Topic
The importance of pressure relief mattresses and regular turning to prevent sores.
Lesson 5: Complications and Long-Term Management
Thromboembolism
1 Topic
DVT prophylaxis, including the use of Clexane and elastic stockings.
Gastric Ulceration & Paralytic Ileus
1 Topic
Management with ranitidine and bowel retraining.
Neurogenic Bladder
1 Topic
Introduction to catheterization and bladder retraining.
Case Study
1 Topic
Ask learners to identify potential complications in a patient with SCI and suggest appropriate interventions.
Lesson 6: Advanced Topics in SCI
Incomplete Cord Injury Syndromes
1 Topic
Central Cord Syndrome, Anterior Cord Syndrome, Brown-Sequard Syndrome, and Conus Medullaris Syndrome.
Priapism and Spinal Shock
1 Topic
Understanding the pathophysiology and clinical management of these signs.
Acute Spinal Cord Injuries Final Assessment & Certification
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Mechanical Injury
Acute Spinal Cord Injuries: A Surgeon’s Perspective
Mechanical Injury
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Direct tissue disruption and motion stresses leading to cord oedema, necrosis, and haemorrhage.
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