What is included in emergency department (ED) care for spinal cord injury (SCI)?

Updated: Nov 01, 2018
  • Author: Lawrence S Chin, MD, FACS; Chief Editor: Brian H Kopell, MD  more...
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Answer

Airway management - The cervical spine must be maintained in neutral alignment at all times; clearing of oral secretions and/or debris is essential to maintaining airway patency and preventing aspiration

Hypotension - Hypotension may be hemorrhagic and/or neurogenic in acute spinal cord injury; a diligent search for occult sources of hemorrhage must be made

Neurogenic shock - Judicious fluid replacement with isotonic crystalloid solution to a maximum of 2 L is the initial treatment of choice; maintain adequate oxygenation and perfusion of the injured spinal cord; supplemental oxygenation and/or mechanical ventilation may be required [4, 5]

Head injuries - Amnesia, external signs of head injury or basilar skull fracture, focal neurologic deficits, associated alcohol intoxication or drug abuse, or a history of loss of consciousness mandates a thorough evaluation for intracranial injury, starting with noncontrast head CT scanning

Ileus - Placement of a nasogastric (NG) tube is essential; antiemetics should be used aggressively

Pressure sores - To prevent pressure sores, turn the patient every 1-2 hours, pad all extensor surfaces, undress the patient to remove belts and back pocket keys or wallets, and remove the spine board as soon as possible


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