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Trauma Update
Geragai Clinic
dr. William Aditya
Geragai- Clinic Medical Lecture
2
Milestone(1)
CharlesASjuntak, FKIK-Unja 4
Milestone(3)
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Spine & Spinal Cord
injury
CharlesASjuntak, FKIK-Unja 9
Confirmation tof significant spine injury
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Classification
Incomplete Complete
Presence of Absence of
Paraplegic/quadriplegic
Spinal instability
Fracture/Sublux Consult
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Screening of Spinal injury(2)
Conscious, neurologis normal:
No neck pain or tenderness
No neck pain or tenderness
Able to concentrate on C-spine
Remove C-collar
If pain
Protection with C-collar & Xray
CharlesASjuntak, FKIK-Unja 15
Screening of Spinal injury(3)
Unconscious patient
Radiographic visualization of
entire spine
Plain films / CT Scan / MRI
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Type 1 injuries
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Type 2 injuries
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Type 3 injuries
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Management of Spinal injury
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Management
Imobilized
Total body
Use padding
Maintain until all can be excluded
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Conservative Management (1)
Ensure adequate ventilation and oxygenation
espeially quadriplegic (c-4)
Maintain blood pressure
Maintain perfusion of spinal cord
Atropine if bradycardia
Methylprednisolone
CharlesASjuntak, FKIK-Unja 24
Conservative Management (2)
Management of Hypotension
Assess for asociated bleeding
Consider neurogenic shock
Monitor urinary output
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Conservative Management(4)
Transfer
Unstable fractures
Neurological deficit
Avoid transfer delay
Properly immobilize entire patient
Provide respiratory support as needed
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Surgical management
CharlesASjuntak, FKIK-Unja 29
Minimally Invasive Spine Surgery
Multiple small incision, cosmetically good
Minimally tissue damage
Early mobilization
Short hospital stay
Minimally bleeding
Safe
A little bit longer operation time
Need C-Arm Xray for guiding
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Question
?
CharlesASjuntak, FKIK-Unja 41
Thank you
CharlesASjuntak, FKIK-Unja 42