We are back with a shadowboxing case!
- Ryan Barnicle
- Thanujaa Subramaniam
- Kole Brownstein
- Scott Weingart
Asia Scoring
IBCC Traumatic Spinal Cord Injury (SCI)
EMCrit 288 – Neurogenic Shock & Should we be Using Vasopressors for Hemorrhagic Shock?
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Editor-in-Chief, at EMCrit.org
An ED Intensivist from NY.
Professor
Nassau University Medical Center
No conflicts of interest (coi).
Professor
Nassau University Medical Center
No conflicts of interest (coi).
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Great Episode, learned a lot
Regarding the bradycardia, would it have been an option to put him on a Isoproteronol drip?
Great episode. Cool point about transvenous PM in this setting, hadn`t thought about that. With regards to airway management in these patients with spinal cord hematoma, you talked about doing what you are comfortable with which is reasonable, but you also say RSI is fine. I have been taught, and it is also my experience that these patient may have considerable prevertebral/retropharygeal edema that may compromise the airway once induced. We evaluate the CT images and often do a topicalized look with VL or flexible scope and decide whether to induce or proceed awake. Any thoughts on where the “cut-… Read more »
From the airway loss point of view, not neck stabilization point of view..
Early on (during their initial presentation) I haven’t found any swelling that impinges on the airway and I think RSI is an acceptable option. And muscle relaxants likely lead to less overall need for applying force to open the mouth. Later on in the patient’s course, I think swelling is going to be more prominent and an awake look may make sense. Will Rosenblatt’s concept of pre-induction naso-laryngoscopy with topical anesthesia in the nose and a small diameter scope is a great way to assess.
Another great shadow boxing episode Scott et all One thing Ive been doing and teaching staff for decades for movement of these pts (log roll, transfer intubation etc) is what I now call the Spock Live Long and Prosper (given that’s our goal for pts) technique- I have them put their distal forearm over the ears and then split their fingers in Spock fashion and wedge them over the medial trapezius- that way they are holding the head but also anchored to the body so things move more securely and in unison IMO- just holding the head I think leaves… Read more »
Just curious is there any CME for this podcast? Also, had a similar case when a 32y male got hit by a car while driving his bike. He had only a C7 spinous fracture. MRI showed edema to the cord with surgery to follow.
cme only on podcasts
Thank you for the outstanding podcast. I always learn so much from the shadow boxing approach.
-Pri Patel