Unanticipated Quadraplegia in an Unconscious Mechanically Ventilated Traumatic Head Injured Patient

Abstract

Objective  A significant number of unconscious patients who present to the emergency department as a result of Road TrafficAccident (RTA) or fall have a major injury to the Cervical Spine. This case highlights the problems of identification of such injuries in the unconscious. CaseReport An unconscious young adult was admitted from the accident and emergency into the intensive care unit with a clinical impression of traumatic head injury. Neck collar was applied and the airway secured with an orotracheal tube. Following positive pressure ventilation for about tenminutes, the patient suddenlywoke up to full consciousness and started shaking his head violently and uncontrollably, necessitating his tracheal extubation. He then complained of his inability to use or feel his limbs. Radiological investigation revealed complete dislocation of first (C₁) and second (C₂) cervical vertebra; a crack in the left temporal skull and a contused left lung.Hewas re-intubated about 20minutes laterwhen his respiratory efforts began to weaken, and ventilated under propofol sedation. He gradually became ventilator dependent, with collapse of cardiovascular and respiratory systems and died on thirteenth day of admission. Conclusion Cervical Spine injury should be suspected in all unconscious patients following trauma.

Key Words: Cervical Spine Injury, Quadriplegia, Mechanical Ventilation.