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 ?
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The Acute Spinal Cord Injury (ASCI) Unit at Groote Schuur Hospital (GSH), which provides a regional provincial service and also deals with referrals from outside the Western Cape province, was established in March 2003 after having been moved from Conradie Hospital owing to provincial restructuring.
The second National Acute Spinal Cord Injury study, which found that a group receiving methylprednisolone within 8 hours of injury had improved motor scores compared with a placebo group [1], was criticized for not including a functional outcome measure.
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If proven successful, surgeons believe the new technique could become a standard protocol in the treatment of acute spinal cord injury.

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