Coda ClinicalCritical CareIntensive CareNeuroTraumaAcute Spinal Cord Injury

Acute Spinal Cord Injury: What Matters by Oli Flower

From CodaZero Live, Oli Flower discusses the emergency management of acute traumatic cervical spinal cord injury.

Oli covers the initial management of patients with traumatic cervical spinal cord injury. He covers the neurological assessment – how and why we do the ASIA or ISNCSCI Exam and why it matters. It is not always straight forward, but getting a motor and sensory level and determining if a patient has perianal sensation and voluntary anal contraction can be really helpful prognostically.

Next, Oli discusses the importance of avoiding hypoxia, including ways to manage an airway in this context.

Oli then talks blood pressure targets – still a controversial area, but aiming for a MAP > 85 mmHg may really help. Hypotension definitely doesn’t help.

Timing of surgery is another hot topic in acute SCI. Low quality evidence suggests surgery in <8 hours of injury improves outcomes, but is this true and achievable? There are many potential benefits in doing surgery early, but it requires the whole healthcare system to work together to make it happen. Then, the age-old topic of steroids in SCI, nothing new here, most centres still avoid methyl prednisolone.

If you are interested in learning more, Oli has been working on a new website with lots more info on managing SCI – check it out at

Finally, if you enjoyed this podcast, there’s plenty more where this came from!

Head to our podcast page to select from 23 categories of medical podcasts. There’s something for everyone! #CodaPodcast

Oliver Flower

Oliver Flower is a staff specialist in Intensive Care Medicine at Royal North Shore Hospital, Sydney. He, along with Roger Harris & Chris Nickson started SMACC and Coda; he came up with the name & logo, finding inspiration in a chewing gum packet, and is the driver behind the design, graphics, branding and marketing of SMACC and Coda. He is a believer in the power of the big crit care community and is a believer in Cadogan’s FOAMed ethos. He runs the educational and networking crit care website Intensive Care Network.