5-18. TREATMENT FOR SPINAL CORD INJURY

The goal of treatment for spinal cord injury is to support the patient's vital functions and prevent further damage. Remember that improper handling of a patient with a spinal injury can cause permanent paralysis. As with assessment, begin the treatment with the ABCs of airway, breathing, and circulation. Then, add the C of cervical spine stabilization and other elements of treatment.

a. A - Airway. Ensure that secretions are not blocking the airway. Have suction equipment available. You may need to clear the airway frequently of blood, saliva, or vomitus. Assure that the airway is open without using the head-tilt method. If movement of the head is necessary to restore an adequate airway, use the jaw-thrust maneuver.

b. B - Breathing. If needed, administer oxygen in high concentration to any patient with marginally effective respirations. (The spinal cord injury may have resulted in edema to the cord. If the necessary oxygen is not delivered, cell death can occur).

c. C - Circulation. Support and monitor the patient's cardiovascular system.

d. C - Cervical Spine Stabilization. Be sure the patient's head and neck have been temporarily stabilized. (This should have been done when his injuries were being assessed.

e. C - Consciousness. Determine the patient's level of consciousness. Use the Glasgow Coma Scale.

f. Control Bleeding. Control bleeding to prevent the loss of blood volume, a possible life-threatening condition.

(1) Administer an IV of lactated Ringer's solution.

(2) Apply medical anti-shock trousers (MAST), if necessary. Bleeding can sometimes be controlled with MAST garments, depending on the location of the injury and the cause of the bleeding. MAST garments are considered to be an intermediate life support measure. The garments are used to create a pressure against the flow of blood thus stopping bleeding.

g. Cover Patient. Keep the patient covered. The patient cannot conserve heat because his body has lost sympathetic tone and blood vessels and arteries have lost their vasoconstriction.

h. Seizures. Be prepared for seizures. Ordinarily, you would not restrain a patient having a seizure. A patient with a spinal cord injury must not move his head and/or neck very much. Therefore, such patients must be restrained during a seizure.

i. Immobilize the Patient on a Long Back Board. Depending on the accident and the position in which the patient is found, he may first need to be splinted onto a short spine board or Kendrick extrication device. With his head, neck, and back stabilized, the patient can then be placed on a long back board.

j. Neurological and Vital Sign Checks. Make frequent neurological and vital sign checks on the patient. Record the results.