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Tue Feb 13 10:02:52 GMT 2007

The terms 'spinal concussion' and 'spinal shock' are already in use
within the specialist SCI service and are already incorporated within UK
national definitions for coding patients and when updating public and
professional knowledge. SCI is a dynamic condition and it is not that
observed 'concussive' trauma has not been present throughout our
history, but rather that the actual incidence appears to be increasing -
just flip through the pages of popular mags like 'Bella' for examples.
So much so that the apparent 'total recovery' from a clinically
demonstrable SCI/Spinal shock has attracted the attention of Spinal
Research (www.spinal-research.org) (previously, the International Spinal
Research Trust) who have created the 'Near Miss Club' in the belief that
by researching survivor's stories, accident histories and their
management and treament pathways that there may be indicatora as to why
one person recovered whilst another one didn't. Similar to how the World
Resus Council reviews CPR outcomes to inform treatment Guidelines. Of
personal interest to me is whether modern emergency care provision along
with road, work, recreational and sporting safety devices, training,
laws and regulations, as well as changes in personal risk-taking
behaviour have contributed to not only the increasing incidence of
concussive cases but also the increase in ultra-high SCI survivors who
would previously have died at scene or shortly afterwards.

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org] On Behalf Of Hardcastle, Tim, Dr
<tch at sun.ac.za>
Sent: 18 January 2007 05:01
To: Trauma &amp; Critical Care mailing list
Subject: RE: Spinal cord injury

John

I like to use the terms autonomic dysfunction for neurogenic and motor
dysfunction for the "spinal" shock. More descriptive

Tim
Dr T C Hardcastle
M.B.,Ch.B.(Stell); M.Med(Chir); FCS(SA)
Senior Surgeon / Senior Lecturer: Surgery (Trauma and ICU) ATLS
instructor and DSTC Cape Town Course Director Intern program
Coordinator: Surgery M.Med (Emergency Medicine) Executive Committee
member Clinical Head (Director): Diana Princess of Wales Trauma Unit
Division of Surgery (General) Room 4064 Department of Surgical Sciences
Tygerberg Hospital / University of Stellenbosch PO Box 19063 Tygerberg
7505 Western Cape South Africa
e-mail: tch at sun.ac.za
Cell: +27824681615
Office: +27219389281 or 4911 pager 0302

-----Original Message-----
From: trauma-list-bounces at trauma.org
[mailto:trauma-list-bounces at trauma.org]On Behalf Of John Holmes
Sent: Thursday, January 18, 2007 1:35 AM
To: trauma-list at trauma.org
Subject: RE: Spinal cord injury

Andreas,

You raise one of my bugbears, namely the nomenclature of "shock" in
spinal trauma.  Unfortunately "spinal shock" and "neurogenic shock" are
sometimes used interchangably for both transient and variably reversible
spinal cord dysfunction and the sympatholytic mediated hypotension
following spinal trauma.

I believe it's time to get rid of such terms altogether.  I propose
"Spinal concussion" for the former and "Spinal injury hypotension" for
the latter scenario.

Spinal concussion is analagous to cerebral consussion and is one of the
reasons definitive assessment of functional spinal injury takes a few
days to delineate after intial injury.

John

Dr John L Holmes
Director Emergency Medicine
Mater Adult Hospital
Brisbane, Australia

>From: "Markus Weis" <trollsjo at gmail.com>
>Reply-To: "Trauma &amp; Critical Care mailing list" 
><trauma-list at trauma.org>
>To: trauma-list at trauma.org
>Subject: Spinal cord injury
>Date: Wed, 17 Jan 2007 18:50:26 +0100
>
>I am quite new to trauma and need some help to understand the 
>pathophysiology of a case.
>
>The patient was brought in with an apparent spinal cord injury. 
>Hypotensive and with no motor or sensory function in the lower 
>extremities. He received fluids and a medium to low dose vasopressor. A

>CT showed a Th6 injury. No other injuries were found. After 2-3 hours 
>in the ICU he started to move his toes (more on one side than the 
>other). Thereafter he was brought to the OR.
>
>Should a spinal or a neurogenic shock not last longer than a few hours?

>What
>if not spinal or neurogenic shock would you call it? Is it a "common"
>phenomenon?
>
>Andreas S
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