Spinal Cord Injury Management

Emergency Management

• First Aid at the Scene:

  • Stabilization of the spine is crucial; especially cervical spine.
  • Treat as if spinal injury has occurred if suspected.
  • Ensure adequate ventilation and circulation.

• Transport to Hospital:

  • Transport to a specialized trauma center if possible.
  • Trauma team preserves neurological function and treats life-threatening conditions.

Hospital Management

• Initial Priorities:

  • Adequate ventilation and oxygenation.
  • Control hemorrhaging and monitor for cardiac arrhythmias or hypotension.

• Neurological Examination:

  • Assess level of consciousness, cranial nerve function, sensation, motor function, and reflexes.

• Imaging Studies:

  • CT scans and MRIs to detect spinal damage.

Surgical and Non-Surgical Interventions

• Non-Surgical:

  • Traction and braces to align the spine and decompress the spinal cord.
  • Common devices include Gardner-Wells tongs and halos.

• Surgical Indications:

  • Unstable fractures, spinal malalignment, and continued cord compression.
  • Surgery can be anterior or posterior.

Pharmacological Management

• Methylprednisolone:
  • Used to lessen secondary injuries.
  • Side effects include gastric ulcers and hypertension.

Complications and Rehabilitation

• Spasticity and Pain Management:

  • Medications like baclofen, Valium for spasticity.
  • Possible baclofen pump.

• Common Complications:

  • Pneumonia, pressure ulcers, and DVTs.

• Autonomic Dysreflexia:

  • Emergent situation mainly with injuries above T6.
  • Signs: Elevated blood pressure, headache, sweating above lesion, and bradycardia.
  • Management: Sit patient up, check for noxious stimuli, and report immediately.

Rehabilitation Phases

• Acute Phase:

  • Prevent secondary complications and prepare for rehab transition.

• Inpatient Rehab:

  • Functional retraining, family training, and vocational planning.

• Outpatient Rehab and Community Reentry:

  • Focus on community reentry skills and driving evaluations.

Neurological Assessments

• ASIA Exam:

  • Determines level and completeness of injury.
  • ASIA Impairment Scale: A (Complete) to E (Normal function).

• Sensory and Motor Function Testing:

  • Importance of knowing dermatomes and myotomes.

Safety and Home Planning

• Discharge Planning:
  • Equipment needs and home safety evaluations.
  • Home exercise programs and community integration.

Conclusion

• Emphasis on the importance of immediate and ongoing management to prevent complications and improve outcomes.