Spinal Cord Injuries: A Suggested Approach

摘要

Management And Evaluation Of Spinal Cord Injuries a.Initial Management and Evaluation Immobilize C-spine Protect airway and insure adequate oxygenation and ventilation. The spinal cord injured patient may have impaired spontaneous ventilatory parameters following trauma, and this impairment subjects these patients to respiratory insufficiency. Neurological deficits can be worsened by hypoxic insults to the injured cord. Many patients with cervical spine injuries may initially be able to maintain adequate ventilation, but will require elective intubation as their respiratory capabilities deteriorate.a. If necessary, oral airwaybrbrb. If necessary, two-person oral intubation with in-line C-spine traction maintained. Do not electively place a too-small tube.brbrc. Serial Mechanics and ABG to assess ventilation and oxygenation. Stabilize blood pressure. Disruption of descending sympathetic pathways results in loss of vasomotor tone and hypotension. Unopposed parasympathetic activity may result in bradycardia. Patients should be resuscitated with crystalloid, red cells and colloid to stabilize blood pressure to approximately 100-110 mm Hg systolic. This resuscitation is important since signs of hypovolemic shock (tachycardia) may be absent in the sympathectomized patient. Other sources of potential hemorrhagic shock must also be ruled out. If the patient is adequately resuscitated and remains hypotensive, dopamine infusion should be initiated. Insert a nasogastric or orogastric tube. Gastric atony may compromise the respiratory status of the patient and lead to aspiration. Insert a Foley catheter if there are no signs of genitourinary trauma. Perform a baseline neurological assessment. Other CNS injuries should be ruled out. Obtain portable C-spine (AP & lateral views) and supine chest x-ray. An abdominal assessment (depending upon the mechanism of injury) may be performed to rule out intra-abdominal injuries. This could be a CT scan, a peritoneal lavage, or a FAST ultrasound.