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Pre-Hospital Care, Model Systems & Local Systems
Lesson 1: Introduction to Acute Spinal Cord Injuries
Aetiology of SCI:
Motor vehicle accidents (MVA)
Sports injuries
Diving accidents
Gunshot wounds (GSWs)
Epidemiology
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
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
Direct tissue disruption and motion stresses leading to cord oedema, necrosis, and haemorrhage.
Biochemical Injury
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
Effects on blood flow and oxygen tension, especially during the first 3-4 hours after injury.
Lesson 3: Acute Management of SCI
Initial Evaluation
History (mode of injury, time since injury, etc.)
Examination (BP, pulse, local tissue disruption, and neurological assessment)
Neurological Grading
Frankel Grading System (A-E)
ASIA (American Spinal Injury Association) Scores
Case Study
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
Indirect (reduction of dislocation) vs. Direct (surgical decompression requiring expertise and imaging)
Blood Pressure Management
The importance of maintaining mean arterial pressure (MAP) to ensure spinal cord perfusion.
Respiratory Support
Ventilation for high cervical injuries and managing complications related to diaphragmatic breathing.
Pressure Sore Prevention
The importance of pressure relief mattresses and regular turning to prevent sores.
Lesson 5: Complications and Long-Term Management
Thromboembolism
DVT prophylaxis, including the use of Clexane and elastic stockings.
Gastric Ulceration & Paralytic Ileus
Management with ranitidine and bowel retraining.
Neurogenic Bladder
Introduction to catheterization and bladder retraining.
Case Study
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
Central Cord Syndrome, Anterior Cord Syndrome, Brown-Sequard Syndrome, and Conus Medullaris Syndrome.
Priapism and Spinal Shock
Understanding the pathophysiology and clinical management of these signs.
Acute Spinal Cord Injuries Final Assessment & Certification
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Ask learners to identify potential complications in a patient with SCI and suggest appropriate interventions.

  1. Pre-Hospital Care, Model Systems & Local Systems
  2. Case Study
  3. Ask learners to identify potential complications in a patient with SCI and suggest appropriate interventions.
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