When a patient is medically stable to transfer from the neuro intensive care unit, they will be transferred to one of two specialized units staffed by highly-specialized nurses, Advanced Practice Nurses and interns trained in the care of the acute spine injury patient.
- Neuroscience Surveillance—10 bed acute care unit
- Neuroscience/Spine—24 bed general care unit
The acute care phase of treatment provides:
- Frequent neurologic monitoring
- Continuation of inpatient rehabilitation therapies
- Development of a discharge plan
- Assessment of rehabilitation needs
- Patient and family education about the injury
Medical Treatment in Acute Care
Medical management of acute spinal cord injury includes but is not limited to the following:
Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE) prevention therapy
Lack of mobility can decrease the blood flow through the veins and cause blood clots to form. When a blood clot forms in a vein deep within the muscle it is called deep vein thrombosis (DVT). These clots can break loose and travel through the bloodstream to the lung and cause a sudden blockage called a pulmonary embolism (PE). Steps taken to deter such an event include:
- Pneumatic compression devices to help blood circulation
- Anticoagulation medications such as: warfarin, heparin and enoxaparin
- Range-of-motion exercises to maintain flexibility and promote circulation
- Weekly blood flow studies for early detection and diagnosis of blood clots
- Surgical placement of an inferior vena cava filter (IVC) is placed in a major vein in the abdomen to block large clots from traveling to the lungs
Gastrointestinal / stress ulcer prevention therapy
Preventative therapy against gastrointestinal/stress ulceration begins early in the critical care phase and may include the use of antacids, histamine-2-receptor antagonists and proton pump inhibitors to neutralize or reduce the production of gastric acid.
Spinal cord injury patients often need help to breathe and may require ventilatory assistance such as intubation. Sometimes a long-term artificial airway called a tracheostomy may be necessary if patients do not have the ability to breathe on their own.
Pneumonia and other respiratory infections are common in patients with spinal cord injuries. To minimize and prevent respiratory complications, an aggressive bronchial hygiene program is implemented by the care team. Individualized care programs may include:
- Turning schedule to change the position of each patient to assist with mobilization of lung secretions
- Assisted exercise designed to promote coughing and deep breathing
- Specialized beds designed to facilitate respiratory management therapy like continuous rotation or chest percussion
Pressure Ulcer Prevention
Prevention begins the moment patients arrive at the hospital. The most common places on the body to develop pressure ulcers are:
- Sacrum (lower back)
- Shoulder blades
To prevent this complication, care providers frequently assess the patient, use specialized lift equipment, implement an aggressive turning schedule and educate the family about the cause and prevention of pressure sores.