3. Perform log roll only (will require more than two people)D. Intravascular fluids (limit to appropriate levels)1. Distinguish neurogenic shock (warm, dry extremities; bradycardia) from hypovolemic shock (cool, clammy skin; tachycardia)E. Monitor blood pressure very closely because perfusion to the spinal cord is crucial1. Hypotension must be avoided to prevent ischemia caused by decreased blood flow and perfusion to the spinal cord, which may produceneuronal injury and neurologic deficit.2. Attempts should be made to maintain MAP at85-90 mmHgF. Bladder catheterizationG. Nasogastric intubationH. Corticosteroids (controversial)1. It may be useful in the early treatment (within the first 8 hr) of patients with acute, nonpenetrating SCI to reduce swelling.a. Reduce damage to cellular membranes that contributes to neuronal death after injuryb. Reduce inflammation near the injuryc. Suppress activation of immune cells that appear to contribute to neuronal damage2. Improvement is noted 6 weeks to 6 months after injury3. Monitor patient for elevation in blood glucoselevels4. Monitor patient for other adverse effects, such as the following:a. Immunosuppressionb. Fluid and electrolyte disturbancesc. Adrenocortical insufficiencyd. Impaired wound healinge. Gastrointestinal disturbancesI. Preliminary clinical trials of another agent, GM-1 ganglioside1. Although evidence does not support a significant clinical benefit, may potentially be useful in acute SCI for preventing secondary damage caused by the following:a. Oxidative free radicalsb. Calcium-mediated damagec. Proteasesd. Cytoskeletal dysfunctione. Excitotoxicityf. Immune reactionsg. Apoptosish. Necrosis2. Studies suggest that it may also improve neurologic recovery from SCI during rehabilitation.J. Antibiotics for penetrating injuriesK. Maintain room temperature; avoid poikilothermyL. Provide meticulous skin care: order rotating bed for respiratory therapy (postural drainage) and skin therapyM. Prepare for insertion of skeletal tongs and traction (Stryker frame, kinetic bed, or halo vest) used to assist in restoration of the spine toa normal position (reduction)1. At least 10 lb of weight is initially applied.
2. Weight is applied on the basis of 5 lb per interspace (i.e., a C5-C6 injury would require 25-30 lb of traction).3. Muscle relaxants are helpful4. Lateral x-rays are taken to assess vertebral alignment as weights are applied.5. Too much weight can pull the spine apart, resulting in distraction injury6. If paralytics are needed, weight may have to be reduced.N. Fixation: involves stabilizing vertebral fracture with wires, plates, and other types of hardwareO. Fusion: involves attaching injured vertebrae to uninjured vertebrae with bone grafts and steel rodsP. Surgery may be indicated to remove bony fragments or to drain hematomas that compress the cordQ. Rehabilitation begins upon admission; follow an interdisciplinary approachR. Electrical stimulation devices or neural prostheses were recently approved by the FDA but are still experimental. These can be implanted in the body to allow some hand movement and bladder/bowel control; some may also assist with breathing.
- Fall '17
- keisha lovence