A 30-year-old Food Panda rider had a head-on collision with a cement truck. When the paramedic assessed him on arrival: Nursing Assignment, SIT, Singapore

A 30-year-old Food Panda rider had a head-on collision with a cement truck. When the paramedic assessed him on arrival, he reported severe pain in his neck and was unable to move his arms and legs. He could not feel his arms and legs. He was drowsy but orientated to his current location.

Vital signs at the scene:

Blood pressure of 100/72 mmHg

Heart rate of 82 per/min

Respirations of 22 per/min.

Pupils equal and reactive to light

Cervical collar applied –

Immobilized head on Ferno Scoop Stretcher.

100% of Oxygen and transported him to the hospital.

Past Medical History

ORIF to Left Trimalleoler fracture 3 years ago.

Social History

Single and lives with elderly parents. Older sister married.

On arrival at ED

Reflexes:

• Minimal biceps brachii stretch reflexes, with no triceps or wrist extensor reflexes
• All other muscle stretch reflexes in the upper and lower extremities were absent

Sensation:

• Perception of sensory stimuli ended bilaterally at an imaginary line drawn across his chest 1/2 inch above the nipples
• Some sensation in his arms, but could not localize touch or describe texture with any consistency there

Strength:

• Able to elevate his shoulders and isometrically contract his biceps brachii slightly in each arm, but could not raise either arm against gravity
• Lower extremities were flaccid, despite attempts to move them

X-Rays:

• Cervical Spine: Unstable C6 Compression Fracture (Burst Fracture)
• Chest: Mild Pulmonary Oedema

CT Spine:

• C6 Lesion with no Vascular Haemorrhages noted but some blood evident at C5-6 with bone fragments in the Spinal Canal

CT Brain:

• Mild Frontal Contusion