Question

B.V., a 24-yr-old white male, is admitted to the emergency department with the diagnosis of a cervical spinal cord injury (SCI). B.V. was swimming at a neighbor's backyard pool. He dove into the shallow end, striking his head on the bottom of the pool. His friends noticed that he did not resurface. They rescued him and brought him to the side of the pool. They maintained neck immobilization until the rescue crews arrived. Patient is awake, alert, anxious, complaining of neck pain. Asking to see his family and why he cannot move his legs. Physical exam shows weak biceps movement bilaterally, no triceps movement bilaterally, gross elbow movement present bilaterally, no movement in bilateral lower extremities, decreased sensation from the shoulders down, no bladder or bowel control. VS BP 85/50 mm Hg; pulse 56 beats/min; respirations 32 breaths/min and labored.

Diagnostics CT C-spine shows C5 subluxation and compression fracture and MRI C-spine shows a severe spinal cord compression at C5-6. Client was intubated in the emergency department, is on a vent, and has tongs/traction upon arrival to the critical care unit.

What would be the first line of treatment for B.V.'s hypotension and bradycardia?

Answer 1

B.V. had a cerical spinal cord injury at the level of C5-C6 and it has lead to spinal shock . Due to which he is having hypotension , bradycardia , tachypnea ,no bowel and bladder control ,weak biceps movement ,no triceps movement and no movement of lower extremities .

The first-line treatment for hypotension is intravenous fluid resuscitation. This is to allow appropriate compensation for the vasogenic dilation that occurred. Treatment for bradycardia is atropine and glycopyrrolate to oppose vagal tone.