Spinal Cord Injuries Part 3: Inpatient Care-Handout: Spinal Cord Injuries Part 3

Handout: Spinal Cord Injuries Part 3

Pdf Summary

The document, titled "Spinal Cord Injuries Part III: Inpatient Care" by Scott Moore, MD, and Nicole Cook MSN, APRN, discusses the comprehensive management of trauma patients with spinal cord injuries, focusing on inpatient care. Accredited by the Accreditation Council for Continuing Medical Education (ACCME), it offers continuing medical education credits for physicians and contact hours for nurses.<br /><br />Key objectives include describing trauma patient care processes, improving outcomes through process changes, and discussing specific inpatient care considerations for spinal cord injuries. <br /><br />The document emphasizes that inpatient care begins in the emergency room and offers a detailed overview of spinal cord injuries' variability and complexity, necessitating individualized care. Respiratory dysfunction varies by injury level, with C1-2 injuries often leading to complete diaphragm paralysis and high mortality without ventilatory support, whereas C6-8 injuries retain diaphragm function but have impaired cough and high fatigue risk.<br /><br />Best practices for acute care include population-specific order sets, patient cohorting, and multidisciplinary approaches while incorporating rehabilitative practices early on to stabilize injuries, prevent secondary damage, and mitigate respiratory complications. Key management strategies include monitoring pulmonary function through tests like Forced Vital Capacity (FVC) and Negative Inspiratory Force (NIF), managing secretions, and a multifactorial approach to respiratory failure.<br /><br />Ventilator management for intubated patients follows ARDSNet guidelines but suggests using high tidal volumes for patients with complete high cervical spine injuries. Current guidelines recommend starting with an initial tidal volume of 8ml/kg and gradually increasing, maintaining specific pressure targets, and enhancing secretion clearance measures.<br /><br />The document outlines neurogenic shock management, emphasizing fluid management and vasopressors, as well as strategies for urinary and bowel management and pressure ulcer prevention through frequent turns and nutritional support. Venous thromboembolism (VTE) prophylaxis is critical, with weight-based chemoprophylaxis noted as the regimen of choice.<br /><br />Pain management should address both nociceptive and neuropathic pain, accounting for the profound psychological impact on patients. Early engagement with support services is vital for addressing the life-altering nature of the diagnosis. <br /><br />The document concludes with the importance of ongoing pulmonary hygiene, increasing rehabilitative therapies, managing spasticity, and educating patients on self-care for successful transitions from critical care. Contact information for the authors is provided for further inquiries.

Keywords

Spinal Cord Injuries

Inpatient Care

Trauma Management

Respiratory Dysfunction

Ventilator Management

Neurogenic Shock

Pain Management

VTE Prophylaxis

Rehabilitative Practices

Pulmonary Function