uke Marks is a 40-year-old male who was brought into ED by ambulance after he came off his motorcycle at 40km/hr after hitting a pothole in the road. The incident was called in by a bystander, an off-duty lifeguard, who helped to stabilise his c-spine by supporting his head (in a badly scratched helmet) and spoke to him until paramedics arrived. Handover from paramedics included: GCS 15, PERRLA, nil evidence of head injury despite a head strike, but Luke was unable to move his arms and legs and stated he had nil sensation in his legs and the sensation in his hands felt strange. The paramedics safely removed his helmet and safely secured a hard collar around his neck before transporting him to hospital. Luke reported pain of 8/10 in his cervical spine but nowhere else. His vital signs were as follows: RR 22, SpO2 98% RA, HR 59bpm, BP 125/63 mmHg, Temp 35.7 degrees. Paramedics administered 8mg IV ondansetron, 5mg s/c morphine and 250ml of NaCl (0.99%) en route. Luke has no significant medical history and takes no regular medications. You are assigned to care for Luke. When you enter his room, he is visibly upset and asks you, "What is happening to me? Why can't I feel my legs?". Vital Signs • BP 100/70 • HR 52 • RR 25 (shallow) • SpO2 95% on RA • Temp 35.4 Electrocardiogram (ECG): Luke's ECG shows he is in normal sinus rhythm (SR). PQRST assessment P - I have pain at rest & pain when I move my neck. Nothing makes it better Q - Sharp stabbing pain R - Neck S - 10 out of 10 T - After crashing my motorcycle Blood Glucose Level (BGL): BGL is 5.5mmol/L Clinical data gathered: --- Peripheral Assessment: • CR <3 secs • Peripheries warm + pink • No peripheral oedema ----- BGL • 5.5mmol ----- Respiratory assessment: • Look - pink, symmetrical + shallow chest movements • Feel - shallow chest movements • Listen - bilateral air entry, nil adventitious sounds Clinical data gathered: --- .Reflex assessment: • Upper- minimal bicep brachii, no tricep or wrist extension. All other upper reflexes absent. • Lower- all absent. ---- Sensation assessment: • Luke can only feel from the top of his head to 2cms above his nipple line. --- Respiratory assessment: • E- Luke's eyes are open as you approach • V- When asked what year it is, Luke responds by saying '2023'. When asked where he is at the moment, Luke responds by saying 'at the hospital'. • M- When asked to open and close his eyes three times, Luke is able to do so. Medical Imaging: CT Spine: C6 lesion with no vascular haemorrhages noted but some blood evident at C5 - 6 with bone fragments in the spinal canal. CT Brain: NAD Cervical spine x-ray: unstable C6 compression fracture Chest x-ray: decreased lung expansion upon inhalation; mild pulmonary oedema Pupillary response assessment: Both pupils are equal and reactive to light: 4+ Limb strength assessment: • Arms = Spastic flexion Luke is able to elevate shoulders and isometrically contract biceps brachii slightly in both arms, could not raise either arm against gravity • Legs = None Luke's lower limbs are flaccid and have no ability to move ABCDE assessment for Luke's? ABCDE Framework for Luke Assessment Findings Actions/strategies Airway Breathing Circulation Disability Exposure
Luke Marks is a 40-year-old male who was brought into ED by ambulance after he came off his motorcycle at 40km/hr after hitting a pothole in the road. The incident was called in by a bystander, an off-duty lifeguard, who helped to stabilise his c-spine by supporting his head (in a badly scratched helmet) and spoke to him until paramedics arrived.
Handover from paramedics included: GCS 15, PERRLA, nil evidence of head injury despite a head strike, but Luke was unable to move his arms and legs and stated he had nil sensation in his legs and the sensation in his hands felt strange. The paramedics safely removed his helmet and safely secured a hard collar around his neck before transporting him to hospital. Luke reported pain of 8/10 in his cervical spine but nowhere else. His vital signs were as follows: RR 22, SpO2 98% RA, HR 59bpm, BP 125/63 mmHg, Temp 35.7 degrees.
Paramedics administered 8mg IV ondansetron, 5mg s/c morphine and 250ml of NaCl (0.99%) en route. Luke has no significant medical history and takes no regular medications.
You are assigned to care for Luke. When you enter his room, he is visibly upset and asks you, "What is happening to me? Why can't I feel my legs?".
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Vital Signs • BP 100/70 • HR 52 • RR 25 (shallow) • SpO2 95% on RA • Temp 35.4 |
Electrocardiogram (ECG): Luke's ECG shows he is in normal sinus rhythm (SR). |
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PQRST assessment P - I have pain at rest & pain when I move my neck. Nothing makes it better Q - Sharp stabbing pain R - Neck S - 10 out of 10 T - After crashing my motorcycle |
Blood Glucose Level (BGL): BGL is 5.5mmol/L |
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Clinical data gathered: --- Peripheral Assessment: • CR <3 secs • Peripheries warm + pink • No peripheral oedema ----- BGL • 5.5mmol ----- Respiratory assessment: • Look - pink, symmetrical + shallow chest movements • Feel - shallow chest movements • Listen - bilateral air entry, nil adventitious sounds |
Clinical data gathered: --- .Reflex assessment: • Upper- minimal bicep brachii, no tricep or wrist extension. All other upper reflexes absent. • Lower- all absent. ---- Sensation assessment: • Luke can only feel from the top of his head to 2cms above his nipple line. --- Respiratory assessment: • E- Luke's eyes are open as you approach • V- When asked what year it is, Luke responds by saying '2023'. When asked where he is at the moment, Luke responds by saying 'at the hospital'. • M- When asked to open and close his eyes three times, Luke is able to do so. |
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Medical Imaging: CT Spine: C6 lesion with no vascular haemorrhages noted but some blood evident at C5 - 6 with bone fragments in the spinal canal. CT Brain: NAD Cervical spine x-ray: unstable C6 compression fracture Chest x-ray: decreased lung expansion upon inhalation; mild pulmonary oedema |
| Pupillary response assessment: Both pupils are equal and reactive to light: 4+ |
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Limb strength assessment: • Arms = Spastic flexion Luke is able to elevate shoulders and isometrically contract biceps brachii slightly in both arms, could not raise either arm against gravity • Legs = None Luke's lower limbs are flaccid and have no ability to move |
ABCDE assessment for Luke's?
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ABCDE Framework for Luke
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Assessment Findings
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