TY  - CHAP
M1  - Book, Section
TI  - Spinal Injuries
A1  - Oropello, John
A1  - Flanagan, Collin
A1  - Wagner, Katherine
A1  - Ullman, Jamie S.
A2  - Schmidt, Gregory A.
A2  - Kress, John P.
A2  - Douglas, Ivor S.
PY  - 2023
T2  - Hall, Schmidt and Wood’s Principles of Critical Care, 5<sup>th</sup> Edition
AB  - KEY  POINTSIn  acute  spinal  cord  injury  (SCI),  primary  injury  determines  the  extent  of  potential  recovery,  and  mitigation  of  secondary  injury  determines  how  much  neurological  recovery  is  obtained.The  prevention  of  secondary  injury,  or  “neuroprotection,”  consists  of  spine  immobilization,  timely  surgical  intervention,  and  early  recognition  and  treatment  of  hemodynamic  instability,  respiratory  failure,  and  hypoxemia.The  baseline  neurological  examination  to  determine  a  neurological  level  and  the  completeness  of  injury,  coupled  with  the  results  of  computed  tomography  and  magnetic  resonance  imaging,  form  the  basis  of  the  neurosurgical  intervention  decision.Acute  SCI  patients,  particularly  those  with  cervical  level  and  severe  SCI,  are  at  risk  for  respiratory  arrest,  hypoxemia,  and  cardiovascular  instability.  Many  patients  with  level  spinal  injuries  will  require  intubation  and  tracheostomy.The  term  “neurogenic  shock”  refers  to  hypotension  due  to  vasodilation  that  may  be  accompanied  by  absolute  (heart  rate  <60)  or  relative  bradycardia  caused  by  the  loss  of  outflow  from  the  sympathetic  autonomic  component  of  the  spinal  cord  arising  from  the  high  thoracic  and  cervical  regions.  This  can  be  seen  at  injuries  to  the  T6  level  and  above.The  American  Association  of  Neurological  Surgeons  level  III  recommendation  is  to  maintain  mean  arterial  pressure  85  to  90  mm  Hg  for  the  first  7  days  after  acute  SCI.Among  trauma  patients,  the  risk  of  venous  thromboembolism  (VTE)  is  likely  highest  after  acute  SCI,  with  an  odds  ratio  of  8.6  compared  to  trauma  patients  without  SCI.  Start  mechanical  thromboprophylaxis  with  intermittent  sequential  compression-decompression  devices  as  soon  as  feasible,  followed  by  chemoprophylaxis;  low-molecular  weight  heparin  lowers  VTE  rates  when  initiated  within  48  hours  of  surgery  for  SCI  and  is  safe  without  increasing  the  risk  of  bleeding  and  mortality.Pulmonary  embolism  (PE)  has  fallen  from  the  third  leading  cause  of  death  within  the  first  year  after  acute  SCI  (14.9%)  to  the  sixth  (3.3%)  leading  cause  of  death.  After  any  sudden  hemodynamic  compromise,  unexplained  dyspnea,  or  hypoxemia,  PE  must  be  considered.Rehabilitation  specialists  should  be  consulted  early  in  the  management  of  persons  with  SCI,  following  spinal  decompression  or  stabilization  and  resolution  of  life-threatening  cardiac  and  respiratory  events.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2023/12/05
UR  - accessanesthesiology.mhmedical.com/content.aspx?aid=1201811242
ER  -