Cite this post as:
Scott Weingart, MD FCCM. Episode 12 – New Trauma Guidelines: ATLS and Spine. EMCrit Blog. Published on April 13, 2013. Accessed on April 19th 2024. Available at [https://emcrit.org/emcrit/atls-and-spine/ ].
Financial Disclosures:
Dr. Scott Weingart, Course Director, reports no relevant financial relationships with ineligible companies.
This episode’s speaker(s), (listed above), report no relevant financial relationships with ineligible companies.
CME Review
Original Release: April 13, 2013
Date of Most Recent Review: Jan 1, 2022
Termination Date: Jan 1, 2025
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Prevention of secondary injury in SCI is key. Many SCI are missed initially, and if you think they’re bleeding you *may* be tempted to not bump up their MAP to 90. If spinal shock, they should be bradycardic instead of tachycardic. And if spinal shock with no obvious bleeding, may not need blood products like you’ve mentioned in the podcast. I think you could give crystalloids and start pressors early, but this is if you suspect SCI and not hemorrhage.
just one point of terminology
spinal shock is not neurogenic shock, which is the correct trauma term in my opinion
spinal shock relates to loss of spinal cord reflexes in acute period of SCI, and these may recover with time.
Sorry. it isa pedantic point by one of my neurosurgical mentors.
Great ‘cast Scott. I (COI: ATLS instructor/course director) agree with your comments that ATLS is a foundation – we as specialists in our fields should certainly be aware of the more current directions…but equally aware of when current trends go awry!
Small correction: ETT cuff pressure should be less than 30 cmH20, not 30 mmHg (a little over 40cmH20). Fortunately, most pressure manometers are marked in cmH20 😉
Ross,
If you asked me clinically, I would absolutely agree with you. 30 cmH2O is our cuff cut-off and the the peds studies cited actually used 20 cm H2O.
However the podcast was based on this document:
http://web15.facs.org/atls_cr/help/9th_Edition_Compendium_for_Update_FINAL.pdf
on the American College of Surgeons website.
So either their summary is incorrect or their rec is high in both of our minds.
Can you take a cell phone shot of anything they have written with the values you mention.
Did they address therapeutic hypothermia (or relative hypothermia) in the acute sci guidelines?
Mary Shue
Emergency Department Pharmacist
University of Michigan Health System
not yet recommended
good point ROss. I did wonder about that mmHg reference too. OUr manometers read in cmH2O as well.
Just a technical glitch – the link for the c-spine update directs to the stroke guidelines. Can it be redirected?
(Neurosurgery 2013;72(supplement 2):1-259 Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries)
re: cuff pressure discussion. the units are a bear here. there are mmHg and mmH2O and cmH2O in regular use in medicine. the 9e FACS ATLS changes doc seems a bit off, as suggested. of the two citations they gave for the 30mmHg sentence quoted above: the first had no mention of appropriate cuff pressures (that i could find) and the second was a prospective trial that used and suggested pressures <= 20cmH20 (equivalent to about 15mmHg, very roughly 1.5x smaller. 1 mmHg = 13.6 mmH2O = 1.36 cmH2O). A quick glance at some random online lit confirms 20-30cmH20 is… Read more »