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no difficult word

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28 y/o male

good immune system

pt is active invidual

young anad healthy

motorcyclist

doesnt have any neurological disorder

high risk getting into accident

involve in vehocle accident

possible life threathening need immediate treatment

cause high impact trauma - vertebral injury/dislocation/spinal cord injuries

complained of severe mid-

back pain and inability to move both legs.

had paralysis both lower limbs

could be sign of spina cord damage

possible affect thoracic vertebra

damage spinal - distrupt motor pathway

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1) question

HOPI

S - MID BACK, exact position when landing

O - sudden or gradual

C - sharp; bone or ligament common w vertebral fracture /dull/shooting ; nerve related

R - spread to other part

A- vomit/headache/profuse sweating/injuries to other part/

T- constant or worsening w movement

E - movement make the pain worse

S - rate scale 0-10/

guna helmet ?

PMH

previous history or surgery

any medication

any chronic illness

microsleep?

RECENT INFECTION

any allergic?

SH

alcohol consumption before riding delivery rider?

posture when driving motor

pakai helmet ke tk?

speed

bonceng org ke tk?

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traumatic spinal cord injuries

vertebra fracture

spinal shock

leg fracture

neurogenic shock

hematoma in spinal cord (compresss)

dislocation

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1. numbness- loss of sensation or tinggling feeling

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1. high speed collision- possible to get back fracture and damage the spinal cord

2. landed on his back on the road surface.- direct spinal effect

3. sudden weakness of bilateral lower limb and numbness below

the chest. - shows primary spunal cors injury..indicate both motor and sensory tract damage ...below the chest t4-t6 dermatome consistent with thoracic spinla cord lesion

4. He wore a helmet and remained conscious after the accident.- still has possibility of head injuries ...isolated spinal injury

5. He also experienced urinary retention (inability to pass urine)- autonomic dysfunction due to spinal cord injury

6. He had no history of alcohol or drug use prior to the accident. - not drunk during riding

7. He had no past medical history- means his condition is due to accident not past illness

8. no family history- rule out any genetically neuronal diseases

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1. vital signs

2. palpation

3. inspection

4. x-ray

5. neurological examination

6. \\

differential diagnosis ^-^

traumatic spinal cord injuries

thoracic (t6 and lower) vertebra fracture

spinal shock

leg fracture

neurogenic shock

hematoma in spinal cord (compresss)

dislocation

traumatic brain injury

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1. bulbocavernosus reflex- test to check if ower part spinal chord (s2-s4) is woring properly, to asset SCI

2. flaccid paralysis - loss of muscle tone an movement due to interuption of motor nerve signals from brain or spinal chord to muscle.

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1. BP low; hypotension- neruogenic shock

2. HR low; bradycardia; neurogenic shock

3. RR slightly inc-

4. O2 normal

5. abdomen was soft and non-tender- no sign of internal bleed or inj

6. the bladder was distended- loss urinary retention, ditrusor muscle coulnt contract, so bladder overfillled

7. flaccid paralysis of both lower

limbs with absent deep tendon reflexes- spinal shock; medhcanism due to loss descending MN

8. Sensory testing demonstrated complete loss of sensation below T5 dermatome- indicate level of SCI (t5 and below)

9. upper limbs were intact, with normal power and sensation- sesnsation can move arms n hands nomally

10. Anal sphincter tone was absent- lesion at t5 (LMN loss function)

11. he bulbocavernosus reflex could not be elicited- ongoing spinal shock

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1. vital signs

2. palpation

3. inspection

4. x-ray

5. neurological examination

6. \\

7. CT scan

differential diagnosis ^-^

traumatic spinal cord injuries

thoracic (t6) vertebra fracture- burst fracture

spinal shock

leg fracture

neurogenic shock

hematoma in spinal cord (compresss)

dislocation

traumatic brain injury

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1. Burst fracture- type of spinal injury where vertebrae breaks due to high axial loading fall from high or car accident

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His investigations showed:

1. ECG: sinus bradycardia

loss of sympathetic tone

2. X-ray spine: burst fracture at T6

confirm vertebrae injury, burst fracture compress spinal cord

3. MRI spine: confirmed burst fracture of T6 with cord

compression

4. He was diagnosed with burst fracture at T6 in spinal shock.

5. admitted to the intensive care unit (ICU) for hemodynamic

monitoring and vasopressor agents.

maintain the perfusion

increased bp by vasoconstriction

6. He underwent surgical stabilisation and spine decompression

under general anaesthesia.

relieve s. cord compression and stabilize the spine

7. He also received opioid receptor

stimulant for management of severe back pain.

severe pain management