case history- 59 m , suffered injuries over head (fore head ) as his car hit an car , injuring 4 other persons gravely. On arrival he was to have minor bruise over forehead, but in a state of shock (PR=56,BP=70/50mm hg, RR=20/min), patient was conscious , responding to verbal commands , confused to place and situation, smelling of alcohol-like , in breath. Chest and abdomen examination was within normal limits. He was able to move all extremities, with some tenderness over spine at the interscapular region.
Past history - known diabetic on metformin therapy, cardiac disease -on pacemaker , chronic alcohol abuser.
patient was resuscitated with crystalloids , received steroids , PPI, analgesics,
responded to initial treatment , shock recovered , consciousness improved , remained confused , talking irrelevant.
NCCT brain , xray cervical , dorsal spine , pelvis -NAD,
after 24 hrs suddenly he complained that he is unable to move his extremities .power 2/5 in all 4 extremities,
the patient was immediately stabilized with cervical collar , and CT CERVICAL spine was done to reveal fracture in C3 lamina .
patient was then started on methyl prednisolone, and shifted to a tertiary center.
1. should all road accidents victims without neurological signs at admission , be evaluated for spine injuries with MRI or CT.?
2. would prophylactic steroids at loading dose help or altered the clinical course?
3. initial resentment against a drunk driver grievously injuring innocent people make the care provider judgmental to ignore the clinical aspects of the patient.