4. Critical Care Management of Acute Spinal Cord Injury

  1. Edward M. Manno MD, FCCM, FAAN, FAHA
  1. Edward M. Manno MD, FCCM, FAAN, FAHA

Published Online: 11 APR 2012

DOI: 10.1002/9781118297162.ch4

Emergency Management in Neurocritical Care

Emergency Management in Neurocritical Care

How to Cite

Manno, E. M. (2012) Critical Care Management of Acute Spinal Cord Injury, in Emergency Management in Neurocritical Care (ed E. M. Manno), Wiley-Blackwell, Oxford, UK. doi: 10.1002/9781118297162.ch4

Editor Information

  1. Neurological Intensive Care Unit Cleveland Clinic Cleveland, OH, USA

Author Information

  1. Neurological Intensive Care Unit Cleveland Clinic Cleveland, OH, USA

Publication History

  1. Published Online: 11 APR 2012
  2. Published Print: 11 MAY 2012

Book Series:

  1. Neurology in Practice

Book Series Editors:

  1. Robert A. Gross and
  2. Jonathan W. Mink

Series Editor Information

  1. Department of Neurology, University of Rochester Medical Center, Rochester, NY, USA

ISBN Information

Print ISBN: 9780470654736

Online ISBN: 9781118297162

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Keywords:

  • critical care management of ASCI;
  • ASCI, devastating, significant consequences;
  • ASIA grading scale;
  • guidelines, for triage patients to centers;
  • patients with documented ASCI, and neuro-imaging;
  • acute management, and endotracheal intubation;
  • critical care issues after ASCI;
  • prophylaxis, in deep venous thrombosis prevention;
  • psychological support, patient with spinal cord injury

Summary

Acute spinal cord injury is a significant problem with long-term consequences. Spinal cord injury can be divided into primary and secondary injuries. The focus of treatment is the prevention of secondary injuries. It is estimated that up to 25% of the final neurological deficit can be attributed to changes that occur after the initial insult. Treatment for the patient involves an initial assessment with a thorough neurological examination and documentation of the level of injury. The most common grading system in use is the American Spinal Injury Association grading scale. Spinal cord trauma is often accompanied by multisystem trauma. Immediate immobilization, radiological evaluation, and assessment for surgery need to be evaluated expeditiously. Cervical spinal cord injury has significant influence on both the respiration and blood pressure. Neurogenic shock is common and hypotension must be treated aggressively to avoid spinal cord hypoperfusion. Acute management of these patients requires the basic ABCs of resuscitation tailored to the particulars of the patient with spinal cord injury. Intensive care unit management focuses on decreasing secondary complications and the maintenance of adequate spinal cord oxygen delivery.