Emergency Department and PICU Clinical Pathway for Evaluation/Treatment of Children with Suspected Traumatic Spinal Cord Injury
- Goals
- Avoid hypotension
- Avoid hypoxia - Titrate supplemental O2 for SpO2 > 92 and < 98%
- Maintain normothermia
- Maintain safety
- Adequate analgesia
- Trauma Team Resuscitation
- ATLS protocol
- Spinal immobilization including cervical collar
- Spinal Trauma Consult – View Procedure
- Resuscitation Complications
- Neurogenic shock
- Spinal shock
- Respiratory Failure
- Temperature instability
Admission to PICU
24 - 48 hours
- Goals
- Avoid hypotension
- Avoid hypoxia - Titrate supplemental O2 for SpO2 > 92 and < 98%
- Prevent secondary neurological injury
- External/internal stabilization of spine, as indicated
- Tertiary exam per ATLS Standard - Treat additional injuries
Stabilization
- Stabilization Complications
- Spinal shock
- Orthostatic hypotension
- Respiratory insufficiency
- Feeding Intolerance
- Temperature instability
48 hours and on
- Goals
- External/internal stabilization of spine, as indicated (if not previously completed)
- ISNCSCI (International Standards for Neurological Classification of Spinal Cord Injury) exam
- Initiate/advance nutrition
- Neurogenic bowel and bladder care
- Adequate analgesia
- Rehabilitation consults/advance in activity
- Prevent/treat SCI related complications
Recovery
- Recovery Complications
- Autonomic dysreflexia
- Respiratory insufficiency
- Neuropathic pain
- Superior mesenteric artery syndrome
- Hypercalcemia
- Joint contracture
- UTI/urosepsis
- Vesicoureteral reflux
- Muscle spasticity
- Scoliosis
- Osteopenia
- Decubitus ulcer
- Goals
- Patient/family education and training
- Discharge Planning
Discharge to Rehabilitation Facility
- Discharge Criteria
- Hemodynamically stable
- Taking adequate calories enterally (PO and/or feeding tube)
- Definitive airway with stable respiratory exam
- Spine stabilized
- Pain managed with enteral or topical medications
- Bowel and Bladder Program initiated
- Skin care regimen in place
- Tolerating increased activity/rehabilitative services
- Other injuries addressed/treatment plan in place
- Family/patient knowledgeable about patient care and indications for inpatient rehabilitation
Resources Contact Info:
- Epic On-Call Finder for:
- Trauma
- Neurosurgery
- Ortho
- Pain Mgt
- Rehab Med
- Wound Care APN: 16787
- Boston Orthotics & Prosthetics (O&P): 215-634-9399
- Specialty Bed: Unit-based CNS or
- Nursing Supervisor (off shifts)
Posted: August 2015
Revised: August 2020
Authors: J. Osipowicz, CRNP; M. Nance, MD; A. Weiss, MD
Revised: August 2020
Authors: J. Osipowicz, CRNP; M. Nance, MD; A. Weiss, MD
Evidence
- Early Acute Management in Adults with Spinal Cord Injury: A Clinical Practice Guideline for Health-care Professionals
- Acute Traumatic Spinal Cord Injury
- Advanced Trauma Life Support (ATLS) -- American College of Surgeons Committee on Trauma
- Pediatric Spinal Cord Injury: A Review by Organ System
- Spinal Cord Injuries in Children and Adolescents
- Rehabilitation of a Child With a Spinal Cord Injury
- Spine Injuries in Polytraumatized Pediatric Patients: Characteristics and Experience from a Level I Trauma Center Over Two Decades
- Spinal Cord Injury-What Are the Controversies?
- Update on Critical Care for Acute Spinal Cord Injury in the Setting of Polytrauma
- Surgical Timing for Cervical and Upper Thoracic Injuries in Patients with Polytrauma