Early treatment for patients with traumatic spinal cord injury produces the best outcomes.
If there’s one thing nurses should know about traumatic spinal cord injury, it’s that early, aggressive treatment is the best hope for keeping a bad situation from getting worse.
“It’s important to be aware that not all injury to the spinal cord occurs at impact,” said Karen A. McQuillan, MS, RN, CCRN, CNRN. “By aggressively managing a lot of risk factors at the beginning, you can reduce the potential for secondary injury and greatly influence the best outcomes.”
About 12,000 spinal cord injury cases occur annually in the U.S., mostly from auto accidents, falls, assaults or industrial and recreational mishaps, according to the National Spinal Cord Injury Statistical Center. Many victims suffer some degree of paralysis, leading to devastating emotional effects and loss of income.
But, as McQuillan points out, aggressive management – from initial trauma care, to critical care and rehabilitation – can lessen nerve damage and even restore some function and abilities.
Initial Care So Important
Upon injury, it’s vital to stabilize the spine with a cervical collar and spinal board so fractures or dislocations of vertebrae don’t cause further damage.
“You keep the spinal column immobilized so there is not progressive injury to the cord,” said McQuillan, clinical nurse specialist at the R Adams Cowley Shock Trauma Center at the University of Maryland Medical Center in Baltimore.
Because respiratory complications often result from severe spinal cord injury, it’s essential to establish an airway. Nurses also will want to monitor blood flow to ensure oxygen and nutrients prevent precious nerve cells from dying.
“A lot of interventions can be taken to ensure good oxygenation and good censing of carbon dioxide,” McQuillan said. “Even a single bout of hypoxia can accelerate the injury.”
Beyond the Cord
McQuillan, who presented a session on traumatic spinal cord injury at the American Association of Critical-Care Nurses NTI conference in May, said nurses treating spinal cord patients must be aware of associated injuries.
Besides trauma to the cord, ligaments and muscles around the spinal column can be bruised or swollen. There could be fractures or dislocations of vertebrae, as well as lacerations, hemorrhaging or vascular damage impeding blood flow.
The challenge is to manage all facets of the injury while also taking into account the patient’s loss of movement, sensation and other body functions.
Respiratory and cardiovascular systems, bowel and bladder functions and the body’s ability to ward off infection all are compromised, making the need for aggressive and appropriate care even more vital.
“Literally every body system can be affected, and you are treating all potential effects of the injury,” McQuillan said.
Long-Term Commitment
The risk of secondary injury continues long after the initial treatment in the trauma center and involves many facets, said Carla A. Aresco, MSN, CRNP, a nurse practitioner at the Cowley Shock Trauma Center.
The critical care nurse is an integral part of the medical team working to reduce that risk.
Those nurses, Aresco said, are the ones with the patient for 12 hours a shift, managing blood pressure and respiratory function and taking steps to prevent infection and further injury.
“They are the gatekeepers in a way, going between the physician, the therapists and the families,” Aresco explained. “And if the patient can talk, they are the ones talking to the patient and including the patient as much as possible in the care plan.”
Hope for the Future
With federal funding and financial support from sources such as the Christopher & Dana Reeve Foundation, researchers are providing new hope for patients with spinal cord injury and paralysis.
New medications could limit the progression of spinal injury, and surgical techniques are being developed to reverse damage and restore function. Stem-cell research offers hope for rebuilding or replacing injured nerve cells, a key to restoring movement.
“There are some drugs and different interventions that are being tested and investigated,” McQuillan said. “There is a lot of hope for good outcomes with spinal cord patients.”
But for nurses hearing her NTI presentation, McQuillan said there are two major take-away points she hopes they picked up. First, understand aggressive management is still the best protection against secondary injury. Also, realize spinal injury affects more than the nervous system, and managing all body systems is essential to the best possible outcome.
“By doing that, we have the best chance of restoring function or at least preserving whatever function the patient has left,” she said.
Jim Kerr is a frequent contributor to ADVANCE.Check out ADVANCE‘s critical care and ED specialty sites!
