Neurological Emergencies—Cervical Spinal Cord Injury

Who is right?

Another way to ask this question is:

Is palpation of the abdomen a reliable way to exclude peritoneal irritation in total and complete spinal cord injury?

If it is, the Revered Attending is correct. If not, score one point for you.

Well, why do abdomens get rigid with irritation? Is a 6 year old consciously tightening his abdomen when his infected appendix bursts? If not, it must be a (say it...) REFLEX.

OK, now we're getting somewhere. What happens to reflexes in acute spinal cord injury? Well, what happens to this fellow's knee jerk? It goes away. So spinal cord reflexes are suppressed immediately after acute spinal cord injury, only to return and become hyperreflexic a few weeks after the acute injury.

So you can't exclude peritoneal irritation (from, e.g., a burst spleen and a belly full of blood) by clinical exam in total and complete spinal cord injury. You must do a peritoneal lavage or CT of the abdomen.

A key principle in trauma: Hypotension is Blood Loss unless you actively exclude all other causes.

Score one for you, Dr. Cushing.