1. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S ASPINAL CORD INJURY14 - September - 2012Prepared By Dr Gamal Soliman1

2. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S ADEFINITION Spina cord injury (SCI) is a traumatic injury to the spinal cord that may vary from a mild cord concussion with transient numbness to immediate and complete tetraplagia. The most common sites are the cervical areas C5, C6 and C7 and junction of the thoracic and lumbar vertebrae, T12, L1.14 - September - 2012Prepared By Dr Gamal Soliman2 3. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S AOBJECTIVE 1. To prevent further trauma. 2. To observe symptoms of progressive neurologic deficits. 3. To improve breathing pattern and airway clearance. 4. To improve mobility 14 - September - 2012Prepared By Dr Gamal Soliman3 4. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A5. To improve sensory and perceptual awareness 6. To relieve urinary retention. 7. Improve bowel function. 8. Absence of complications 9. Promote comfort.14 - September - 2012Prepared By Dr Gamal Soliman4 5. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S APOLICY 1. Assessment of patient with spinal cord injury include: Patent airway Location and severity of cord damage Neurologic level of injury Vital signs 14 - September - 2012Prepared By Dr Gamal Soliman5 6. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A2. Injuries to the spinal column include: Fracture with and without bone displacement Dislocations Ligament sprains Disk injury, including compression14 - September - 2012Prepared By Dr Gamal Soliman6 7. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A3. Any unconscious patient who is the victim of accident must be assessed to have spinal injury. 4. All unconscious trauma patients and all patients with possible spinal injuries should be rigidly immobilized.14 - September - 2012Prepared By Dr Gamal Soliman7 8. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 20125. Signs and symptoms include: Pain without movement Pain with movement Tenderness Deformity Impaired breathing Priapism Characteristic positioning of the arm. Involuntary loss of bowel and bladder control. Nerve impairment to the extremities Prepared By Dr Gamal Soliman 5.10 Nerve shock8 9. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S AMATERIALS & EQUIPMENT 1. Spinal bed 2. Cervical collar 3. Sand bags 4. Oxygen equipment14 - September - 2012Prepared By Dr Gamal Soliman9 10. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A5. Suction machine 6. Cardiac monitor 7. Pulse oximetry 8. Nasogastric tube. 9. Urinary catheter. 14 - September - 2012Prepared By Dr Gamal Soliman10 11. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A1. Obtain history of the accident: 1. To determine data baseline. 1.1 Neck and back pain 1.2 Numbness 1.3 Tingling 1.4 Sensation in extremities14 - September - 2012Prepared By Dr Gamal Soliman11 12. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A2. Assess the following: 2.1Cardiopulmonary status 2.2 Loss of consciousness 2.3 Note signs and symptoms of spinal shock such as: flaccid, paralysis, urinary retention, absent reflexes14 - September - 2012Prepared By Dr Gamal Soliman12 13. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A2.414 - September - 2012Bowel and bladder function. 2.5 Quality, location, severity of pain. 2.6 Depression, powerlessness, dependence, passivity 2.7 Changes in motor and sensory function 2. Data baseline to determine degree of autonomic dysfunction. Prepared By Dr Gamal Soliman 13 14. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A3. Maintain patent airway, be prepared to intubate if respiratory arrest occurs. 4. Administer oxygen as ordered 4.1 Monitor saturation through pulse Oximetry. 5. Immobilize the head and neck:14 - September - 2012Prepared By Dr Gamal Soliman14 15. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A3. Maintain patent airway, be prepared to intubate if respiratory arrest occurs. 4. Administer oxygen as ordered 4.1 Monitor saturation through pulse oximetry. 14 - September - 2012Prepared By Dr Gamal Soliman15 16. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A3. Maintain patent airway, be prepared to intubate if respiratory arrest occurs. 4. Administer oxygen as ordered 4.1 Monitor saturation through pulse oximetry.14 - September - 2012Prepared By Dr Gamal Soliman16 17. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A5.2 Apply cervical collar 5.3 Provide sand bags14 - September - 2012Prepared By Dr Gamal Soliman17 18. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A6. Check and monitor vital signs 6. Patient with SCI can be hypotensive due to the effect of injury on the Sympathetic nervous system.14 - September - 2012Prepared By Dr Gamal Soliman18 19. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A6. Provide I.V. access for: 7.1 I.V. fluids 7.2 I.V. medications as ordered 7.3 Blood extraction. 7. To facilitate immediate administration of emergency drugs as ordered14 - September - 2012Prepared By Dr Gamal Soliman19 20. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A8. Place patient on firm bed until spinal cord stabilization. 8. To ensure good alignment. 9. Insert nasogastric tube as paralytic 14 - September - 2012Prepared By Dr Gamal Soliman20 21. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A10. Measure intake and output. 10.1 Intermittent catheterization14 - September - 2012Prepared By Dr Gamal Soliman21 22. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A10.2 Encourage fluid intake. 10.2 To prevent infection and urinary calculi. 11. Expedite admission to ICU14 - September - 2012Prepared By Dr Gamal Soliman22 23. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman23 24. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman24 25. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman25 26. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman26 27. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman27 28. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman28 29. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman29 30. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman30 31. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman31 32. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman32 33. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman33 34. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman34 35. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman35 36. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman36 37. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman37 38. S ilv e r C r e s c e n t D is p e n s a r y K h o b a r - K S A14 - September - 2012Prepared By Dr Gamal Soliman38