Conclusion

In patients with cervical spine injury, the medical treatment aims at decompression of the spinal cord and reversal of neurogenic shock (maintain spinal cord perfusion) and respiratory failure (maintain normoxia, avoid hyperventilation). Collar devices and/or manual in-line traction will immobilize the neck and support decompression of the spine. Treatment of neurogenic shock includes fluid replacement using crystalloid or colloid solutions to maintain arterial blood pressure, circulatory volume, renal function, and tissue oxygenation. Atropine will reverse bradycardia and increase cardiac output. Administration of vasopressors is appropriate only after restoring intravascular volume. Respiratory function is related to the level and degree of spinal cord injury and other trauma sustained at the time of injury. Tracheal intubation is indicated in unconscious patients, during shock, in patients with associated injuries, cardiovascular, or respiratory distress, and in conscious patients with vital capacity below 1000 ml. Plasma glucose concentration should be managed within the range of 100 to 150 g/dl, and normothermia should be maintained until the neuroprotective effects of mild hypothermia are confirmed clinically. Infusion of methylprednisolone (a 30-mg/kg bolus followed by 5.4 mg/kg/h for 23 h) is indicated within the first 8 h of injury.

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