Page 310 - Critical Care Nursing Demystified

Chapter 6 CARE OF THE TRAUMATIZED PATIENT 295

some functions during 1 week to 6 months after the injury. But the likelihood
of full recovery diminishes after 6 months. Generally, serious, long-term reha-
bilitation is needed.

Interpreting Test Results
X-rays of C-spine
CT will be negative for injury

Hallmark Signs and Symptoms

Pain
Paresthesias
Paralysis
Palor above the level of the cord injury

Difficulty breathing if C4 or above

NURSING ALERT

A patient with a C5 or above SCI may have difficulty breathing. Monitor these pa- Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
tients closely and if respiratory distress occurs, prepare to support ventilatory efforts
with BiPAP, intubation, or MV.

Treatment
Decompression of the spinal cord through realignment can be done medically
or surgically depending on the types and extent of identified injuries. Medical
management of SCI involves immobilization of the fracture site and realign-
ment of any dislocation. Closed reduction of a cervical fracture can be done by
using skeletal traction, which is indicated if the fracture is unstable or sublux-
ated. Crutchfield tongs and halo vests are examples of skeletal traction devices
for cervical injuries. They comprise two four-point tongs inserted into the skull
through shallow burr holes under local anesthesia and connected to traction
weights. The halo traction brace allows the patient to ambulate and participate
in self-care. Thoracic and lumbar injuries can be treated by using fiberglass or
plastic vests, canvas corsets, or a Jewett brace. These devices are fitted to the
patient to provide support and stabilization of the spine. The recommended
treatment for sacral and coccygeal injuries is bed rest.
Surgical management of SCI results in a more normal alignment of the liga-
ments and bone of the spinal column to provide spinal column stability and