Spinal Cord Injury, SCI, Traumatic — Stabilization Complications — Clinical Pathway: Emergency and Inpatient

Spinal Cord Injury (SCI) Clinical Pathway — Emergency Department and ICU

Complications: Stabilization Phase

Spinal Shock Pathophysiology
  • Complete loss of motor, sensory, reflex (including rectal tone), and autonomic function below a specific level of injury
Clinical manifestations
  • Transient — can begin 30-60 minutes following a SC injury and last up to six weeks post-injury
  • NOT to be confused with neurogenic shock
Alert FLOC for changes in rectal tone
Orthostatic Hypotension Pathophysiology
  • Due to peripheral vasodilatation
Clinical manifestations
  • Decreased BP and/or increased HR when in upright position
  • Other symptoms: dizziness, lightheadedness, syncope, possible visual disturbances
Prevention
  • Gradual position changes
  • Compression stockings, abdominal binders to decrease venous pooling
Respiratory Insufficiency Pathophysiology
  • C3-C5 injuries associated with:
    • Hypoventilation, atelectasis, mucous plugging, and ventilation–perfusion mismatch
  • Midthoracic and above injuries associated with:
    • Expiratory muscle weakness with ineffective cough and secretion clearance
    • Disruption of sympathetic input to the bronchi with increase in bronchial secretion production
Treatment
  • Chest physiotherapy, incentive spirometer, cough assist, manually assisted coughing (“quad coughing”)
  • Abdominal binder when sitting up
  • Early mobilization (if spine stabilized)
Neuropathic Pain Clinical manifestations
  • Often described as “pins and needles,” body part “is asleep,” “tight belt” at level of injury, burning, stabbing, or electrical in quality
  • May follow dermatomes
Treatment
  • Antidepressant, antiepileptic, standard analgesic medications are often used in combination. May include:
    • Gabapentin
    • Trazodone or Amitriptyline
    • Opiates
Feeding Intolerance Pathophysiology
  • May be secondary to medications, ileus, immobility, or neurogenic bowel
Treatment
  • Specific to cause
  • Limit narcotics, incorporate pro-kinetic agents, decompression with rectal tube
  • NPO until bowel sounds return
Gaseous distention decompression technique
  • Lubricate the tip of a red rubber catheter with water-soluble lubricating jelly
  • Gently insert red rubber catheter 1 inch into the rectum or past the internal anal sphincter
  • Leave in place for 2 hours 2-3 times a day
  • Closely assess skin for breakdown
Warning
  • Red rubber catheters contain latex
  • Discuss with FLOC if the patient has a latex allergy or sensitivity
UTI/Urosepsis Clinical manifestations
  • Fever, chills, incontinence between catheterizations, malaise
Treatment
  • Urinalysis; urine culture; antibiotics per species/sensitivities
Vesicoureteral Reflux Pathophysiology
  • Secondary to high bladder pressures and recurrent UTI
Treatment
  • Increased frequency of catheterization, Urology consult