Depending on the extent of the spinal cord injury or the complexity of surgical procedures performed to stabilize the injury, patients will be taken to the Neuro-Spine Intensive Care Unit (NSICU). Typically, patients who are admitted to the NSICU require a breathing tube and ventilator. During the NSICU stay, registered nurses frequently assess patients' blood pressure, heart rate and breathing rate using sophisticated monitoring devices and perform tests to check for weakness, paralysis, spasticity and loss of feeling in the arm, torso or legs.
During the ICU stay, patients will be seen by a medical team that includes:
- Physicians specializing in orthopaedics or neurosurgery
- Physicians specializing in neuro-intensive care
- A physiatrist specializing in spinal cord injury and rehabilitation
- Advanced practice nurses (APN) and registered nurses (RN) proficient in the care of spinal cord injury and intensive care
- Respiratory therapists
- Occupational and physical therapists
- Social workers
- Case managers
Once the medical team is confident that a patient's vital signs, bodily functions, and spinal cord injury are stable, the patient will be transferred to the telemetry floor (for continuous heart rate monitoring) or to a rehabilitation center that specializes in the treatment of spinal cord injuries.
Patients in the ICU require multiple medications to manage the complicated nature of spinal cord injury. Medications are used to:
- Improve spinal cord function
- Regulate heart rate and/or blood pressure
- Ease digestive problems
- Assist with bowel or bladder functioning
- Promote the healing of skin, muscles and bone
Types medications used to treat spinal cord injury in the ICU include:
Corticosteroids (dexamethasone or methylprednisolone) are used to reduce swelling around the injured area of the spinal cord which reduces or relieves paralysis. Swelling may lead to further damage to the spinal cord if left untreated.
Pain medications (Narcotics) will initially be used to control pain after the injury. If pain continues, other options to control it may include:
- Non-steroidal anti-inflammatories (Toradol, Motrin, Advil)
- Antispasmodics (Baclophen, Flexeril)
- Benzodiazepines (Valium)
- Neuropathic pain agents (Neurontin, Elavil)
Nutrition supplements are used after the initial injury, such as multivitamins, zinc, calcium, or vitamin C, to help promote skin and bone healing and general health.
Insulin may be given if high blood sugar levels develop. High blood sugar is sometimes a side effect of corticosteroids.
Bowel medication is given to help patients have regular bowel movements. When the spinal cord is injured, the stomach and bowels do not work well for a period of time, and bowel medications help combat that.
Antispasmodic medications like Baclofen, Flexeril and Valium are given to relieve or prevent muscle spasticity. Spasticity is an abnormal increase in muscle tone causing muscles to continually contract. Continual contraction of the muscles causes tightness or stiffness of the muscles that may interfere with movement. Spasticity can occur when the muscles are stretched or irritated below the level of the spinal cord injury.
The total extent of the spinal cord injury may not be visible immediately after an injury; physicians often order many diagnostic tests while patients are in the ICU. Diagnostic tests may include:
- Blood tests
- Computed Tomography scan (CT scan)
- Magnetic Resonance Imaging (MRI)
- Other surgical options to be determined by the doctor