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Continuing Education in Anaesthesia, Critical Care & Pain Advance Access originally published online on May 4, 2009
Continuing Education in Anaesthesia, Critical Care & Pain 2009 9(3):82-86; doi:10.1093/bjaceaccp/mkp013
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© The Author [2009]. Published by Oxford University Press on behalf of The Board of Directors of the British Journal of Anaesthesia. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournal.org

Cervical cord injury and critical care

Michelle Denton, MBChB FRCA
Specialist Registrar in Anaesthesia
Leeds General Infirmary
Great George Street
Leeds LS1 3EX
UK

Justin McKinlay, MA (Oxon) BM BCh FRCA
Consultant in Anaesthesia and Critical Care Medicine Leeds
General Infirmary
Great George Street
Leeds LS1 3EX
UK
Tel: +44 113 3926672
Fax: +44 113 3922645
E-mail: justin.mckinlay@leedsth.nhs.uk (for correspondence)

The first 150 words of the full text of this article appear below.


Key points

Respiratory complications are the leading cause of death after cervical cord injury.
Marked changes in respiratory physiology occur and recovery can be prolonged.
In patients with high cervical cord injuries, the supine posture improves respiratory function. The erect posture will actually worsen breathing and should be avoided unless used in conjunction with an abdominal binder.
Neurogenic shock occurs in all lesions above T6 because of interruption of the sympathetic nervous system and unopposed vagal tone.
Other injuries are commonly associated with cervical cord injury and a full secondary survey must be completed.

 

The majority of spinal cord injuries (SCI), involving previously healthy young adults, result from trauma; 37% occur after road accidents, 42% follow falls, 11% are associated with sports and recreational activities, and 3% after assault.1 There is a male predominance of 4:1.

Respiratory complications are the leading cause of death in the long and short term.1, 2 . . . [Full Text of this Article]


   Respiratory system
 
Physiological changes after SCI

Early respiratory management

Airway

Physiotherapy

Mucolytics

Posture

Abdominal binding

Preventing fatigue

Non-invasive ventilation

Bronchoscopy

Mechanical ventilation

Weaning from mechanical ventilation

Long-term respiratory management

Tracheostomies

Weaning strategies

Speaking

Exercise training

Diaphragmatic pacing


   Cardiovascular system
 
Neurogenic shock

Thromboembolism

Sympathetic hyperreflexia


   Gastrointestinal (GI) system
 
Delayed gastric emptying and paralytic ileus

Gastric stress ulceration

Constipation


   Metabolic considerations
 
Temperature regulation

Hyperglycaemia

Steroids and acute spinal cord injury


   Other considerations
 
Psychological aspects

Pain management

Spasticity


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