Case Study 71 Year Old Spinal Cord Injury
So I previously attended a 71 year-old male presenting with an episode of chest tightness approximately 12 hours before we got there. It had lasted around half an hour then it resolved on its own.
This patient had a previous spinal cord injury to his C5/6 vertebrae, approximately forty years prior, causing him to be diagnosed with paraplegia, requiring a wheelchair and 24/7 at home care.
Upon our examination, the patient’s observations were all normal, although blood pressure was slightly elevated. We decided to repeat the blood pressure, however, each time we repeated it we seemed to be getting a higher reading than before with no clear anatomical reasoning behind it.
Here’s a brief table of observations. You can find the full table in the appendix at the bottom
| Time | HR | SpO2 | NIBP (MAP) |
|---|---|---|---|
| 00h 00m | 146/78 (101) | ||
| 00h 17m | 94 | 96 | 189/99 (129) |
| 00h 29m | 93 | 95 | 191/157 (168) |
| 00h 56m | 93 | 95 | 158/98 (118) |
| 01h 00m | 89 | 95 | 183/133 (150) |
As shown by the table, the blood pressure climbed by over 40 mmHg systolic before it eventually started coming down, although it did start coming back up again.
I had never heard of this condition before, but my mentor explained that it was likely due to something called “autonomic dysreflexia”.
Spinal Cord Injuries
Spinal cord injuries (SCIs) are the largest killer of under forty-five-year olds across the United Kingdom, with approximately 1000 new SCI patients diagnosed each year (for Health & Excellence, 2016), most frequently due to road traffic collisions, falls and assaults, and often lead to tetraplegia, paraplegia and, of course, death.
Appendix
Appendix 1: Full Table of Observations
| Time | HR | SpO2 | NIBP (MAP) |
|---|---|---|---|
| 00h 00m | 146/78 (101) | ||
| 00h 09m | 94 | 97 | 164/94 (117) |
| 00h 11m | 94 | 97 | 166/94 (118) |
| 00h 15m | 97 | 96 | 171/92 (118) |
| 00h 17m | 94 | 96 | 189/99 (129) |
| 00h 18m | 96 | 96 | 185/100 (128) |
| 00h 23m | 87 | 96 | 189/100 (130) |
| 00h 26m | 95 | 96 | 186/103 (131) |
| 00h 29m | 93 | 95 | 191/157 (168) |
| 00h 30m | 94 | 95 | 171/103 (126) |
| 00h 33m | 97 | 96 | 171/103 (126) |
| 00h 35m | 96 | 95 | 170/102 (125) |
| 00h 38m | 91 | 95 | 168/101 (123) |
| 00h 41m | 94 | 95 | 168/100 (123) |
| 00h 42m | 85 | 95 | 166/103 (124) |
| 00h 45m | 91 | 95 | 166/101 (123) |
| 00h 48m | 89 | 95 | 164/99 (121) |
| 00h 52m | 91 | 95 | 161/75 (104) |
| 00h 56m | 93 | 95 | 158/98 (118) |
| 01h 00m | 89 | 95 | 183/133 (150) |
References
- Association of Ambulance Chief Executives and Joint Royal Colleges Ambulance Liaison Committee. (2019). JRCALC Clinical Guidelines 2019 (S. N. Brown, D. S. Kumar, C. James, & J. Mark, Eds.; p. xiv). Class Professional Publishing.
- Boran, S., Lenehan, B., Street, J., McCormack, D., & Poynton, A. (2011). A 10-year review of sports-related spinal injuries. Irish Journal of Medical Science, 180(4), 859–863. https://doi.org/10.1007/s11845-011-0730-4
- for Health, N. I., & Excellence, C. (2016). Spinal injury: assessment and initial management. National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ng41/chapter/recommendations#assessment-and-management-in-prehospital-settings