SPINAL CORD INJURY

DEFINITION

Spina cord injury (SCI) is a traumatic injury to the spinal cord that may vary from a mild cord concussion with transient numbness to immediate and complete tetraplagia. The most common sites are the cervical areas C5, C6 and C7 and junction of the thoracic and lumbar vertebrae, T12, L1.

OBJECTIVE

1.To prevent further trauma.

2.To observe symptoms of progressive neurologic deficits.

3.To improve breathing pattern and airway clearance.

4.To improve mobility

5.To improve sensory and perceptual awareness

6.To relieve urinary retention.

7.Improve bowel function.

8.Absence of complications

9.Promote comfort.

POLICY

1.Assessment of patient with spinal cord injury include:

Patent airwayLocation and severity of cord damageNeurologic level of injuryVital signs

2.Injuries to the spinal column include:

Fracture with and without bone displacement Dislocations Ligament sprains Disk injury, including compression

3.Any unconscious patient who is the victim of accident must be assessed to have spinal injury. 4.All unconscious trauma patients and all patients with possible spinal injuries should be rigidly immobilized.

5.Signs and symptoms include: Pain without movement

Pain with movement

Tenderness

Deformity

Impaired breathing

Priapism

Characteristic positioning of the arm.

Involuntary loss of bowel and bladder control.

Nerve impairment to the extremities

5.10 Nerve shock

MATERIALS & EQUIPMENT

1.Spinal bed2.Cervical collar3.Sand bags4.Oxygen equipment

5.Suction machine6.Cardiac monitor7.Pulse oximetry8.Nasogastric tube.9.Urinary catheter.

1. Obtain history of the accident:1. To determine data baseline.1.1Neck and back pain1.2Numbness1.3Tingling1.4Sensation in extremities

2. Assess the following: 2.1Cardiopulmonary status2.2Loss of consciousness2.3Note signs and symptoms of spinal shock such as: flaccid, paralysis, urinary retention, absent reflexes

2.4Bowel and bladder function.2.5Quality, location, severity of pain.2.6Depression, powerlessness, dependence, passivity2.7Changes in motor and sensory function2. Data baseline to determine degree of autonomic dysfunction.

3. Maintain patent airway, be prepared to intubate if respiratory arrest occurs. 4. Administer oxygen as ordered 4.1 Monitor saturation through pulse Oximetry. 5. Immobilize the head and neck:

3. Maintain patent airway, be prepared to intubate if respiratory arrest occurs.

4. Administer oxygen as ordered 4.1 Monitor saturation through pulse oximetry.

3. Maintain patent airway, be prepared to intubate if respiratory arrest occurs.

4. Administer oxygen as ordered

4.1 Monitor saturation through pulse oximetry.

5.2Apply cervical collar5.3Provide sand bags

6. Check and monitor vital signs 6. Patient with SCI can be hypotensive due to the effect of injury on the Sympathetic nervous system.

6.Provide I.V. access for:

7.1I.V. fluids7.2I.V. medications as ordered7.3Blood extraction.7. To facilitate immediate administration of emergency drugs as ordered

8. Place patient on firm bed until spinal cord stabilization.8. To ensure good alignment. 9. Insert nasogastric tube as paralytic

10. Measure intake and output.

10.1 Intermittent catheterization

10.2 Encourage fluid intake.10.2 To prevent infection and urinary calculi. 11. Expedite admission to ICU