Critical Care Management of Acute Spinal Cord Injury

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.