SMACC 2014 PK spinal cord injury

Spinal Cord Injury

Management Controversies in

#1

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#2

ASIA Scale

#3

Spinal Shock

Neurogenic Shock

from acute spinal cord injuryloss of reflexes and flaccid paralysistransient (days to months)no specific treatment

haemodynamic phenomenondue to sympathetic denervation

and unopposed vagal activityfluids/pressors

#4

http://www.learnicu.org/Docs/Guidelines/CSCMAcuteManagementSpinal.pdf#5http://journals.lww.com/neurosurgery/toc/2013/03002

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#5

Occiput

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#8

#9

Image Credit DOI: 10.4103/0970-9185.117053#10

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Cerebral Perfusion

Pressure

#11

Spinal Cord Perfusion

#12

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#13

Episode 1: A New Hope?The NASCIS Trilogy

#14

Episode 2: The steroids strike back

#15

Standard of Care

Episode 3: Return of the steroids (oh please can we stop the Star Wars theme now?...)

#16

2002 & 2012...

Oh no it’s worse than the Phantom Menace...

#17

Image Credit: Seth Anderson on Flickr, https://secure.flickr.com/photos/swanksalot/

Text Credit: Chris Nickson on LITFL, http://lifeinthefastlane.com/education/ccc/trauma-literature-summaries/#18

PMID 23417182#19 image credit: http://antisteroid.wordpress.com

Kudos to Oli Flower and ICN Podcast #3

http://www.intensivecarenetwork.com/index.php/icn-activities/icn-podcasts/144-podcast-3-the-acute-

management-of-spinal-cord-injury

#20

Thanks for watching