acute spinal cord injury

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acute spinal cord injury

Acute traumatic injury of the spinal cord. Signs and symptoms depend upon the vertebral level injured and degree of injury. Damage may be due to the initial injury and to any inflammatory response or swelling that occurs in the next 48 to 72 hr. Therapy includes immobilization, high doses of corticosteroids, airway maintenance, cardiovascular resuscitation, and insertion of an indwelling catheter. The use of intravenous methylprednisolone given as a bolus dose of 30 mg/kg and then a maintenance dose of 5.4 mg/kg/hr for 24 to 48 hr during the acute phase improves neurological recovery and may reduce edema.

Patient care

Cooling the patient or the spinal cord has theoretical advantages, but clinical benefit has been difficult to document. Immediately after a spinal cord injury, the spine must be stabilized, adequate ventilation and circulation maintained, and problems with thermoregulation and urinary retention assessed and treated. After initial stabilization, all general patient care concerns apply. The patient is assessed for evidence of paralysis, loss of sensation or reflexes, pneumonia, deep vein thrombosis, pulmonary embolism, decreased peristalsis, gastrointestinal bleeding, and problems associated with immobilization. Explanations of all procedures and support are provided to the patient and his or her supporters. Anxiolytics (if needed) should be administered as prescribed and their effects evaluated. The patient with serious trauma to the spinal cord may suddenly confront many challenges to body image and functional independence, including changes in mobility, urinary and fecal continence, erectile function, skin integrity, and mood. A sensitive and caring multidisciplinary approach to rehabilitation is needed to help the client.

See also: injury
References in periodicals archive ?
Histologic characterization of acute spinal cord injury treated with intravenous methylprednisolone.
We investigated the bladder drainage method among 117 acute spinal cord injury patients; 88 of them were using clean intermittent catheterization (CIC), 17 patients were using an indwelling Foley catheter, and 12 patients had catheter-free voiding function.
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A critical appraisal of the reporting of the National Acute Spinal Cord Injury Studies (II and III) of methylprednisolone in acute spinal cord injury.
Pathophysiology and pharmacologic treatment of acute spinal cord injury.

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