Chapter 14, Problem 2CCS

10-Year-Old Boy with Spinal Injury

On arrival at Holyoke Hospital, Jimmy Chin, a 10–year-old boy, is immobilized on a rigid stretcher so that he is unable to move his head or trunk. The paramedics report that he was awake and alert after his accident at the skateboard park, but crying and complaining that he couldn't get up and that he had a “wicked headache." He has severe bruises on his upper back and head, and lacerations of his back and scalp. His blood pressure is low, body temperature is below normal, lower limbs are paralyzed, and he is insensitive to painful stimuli below the nipples. Although still alert on arrival, Jimmy soon begins to drift in and out of unconsciousness.

Jimmy is immediately scheduled for a CT scan, and an operating room is reserved.

Relative to Jimmy's condition:

2. What do his worsening neurological signs (drowsiness, incoherence, etc.) probably indicate? Relate this to the type of surgery that will be performed.