Case

Scenario

Scenario 4
Joseph is a 28 year old man who fell from his roof while xing
his TV antenna. He was found to have T10-T11 fracture with
paraplegia. He was iniBally admiCed to the SICU and placed on
high dose steroids for 24 hours. He was taken to surgery 48
hours post-accident for spinal stabilizaBon. He spent 2
addiBonal days in the SICU. 5 days on the Neuro Ward and now
is ready to be transferred to you Medical-Surgical Ward. He
conBnues to have no movement on his lower extremiBes.

Questions:
The goal of treatment in the acute phase of spinal cord injury
is to help Joseph survive the injury and maintain physiologic
stability through the period of spinal shock. What is spinal
shock? How is it managed?
Joseph received high dose steroid therapy every 24 hours,
then placed on smaller maintenance doses. What eect will
steroids have on Joseph?

The goal of treatment in the acute phase of spinal cord injury is

to help Joseph survive the injury and maintain physiologic
stability through the period of spinal shock. What is spinal
shock? How is it managed?
Spinal shock following a spinal cord injury is a specic term that relates
to the loss of all neurological acBvity below the level of injury. This loss
of neurological acBvity include loss of motor, sensory, reex and
autonomic funcBon. Spinal shock is a short term temporary physiologic
disorganizaBon of spinal cord funcBon that can start between 30-60
minutes following a spinal cord injury. Spinal shock can last up to six
weeks post injury.

Management:

Airway Management
Relieve Pressure and Alignment of Spine
Hypotension, hemorrhage and shock
Vital Signs (Autonomic Control)
Skin (Pressure Ulcer)
Sexual, Bladder and Bowel FuncBon
Psychological FuncBon

Joseph received high dose steroid therapy every 24 hours, then

placed on smaller maintenance doses. What effect will steroids
have on Joseph?

Reduce secondary eects of Spinal Cord Injury

Reduce swelling and inammaBon of the Spinal Cord
Sensory and Motor Improvements
Reduce the cellular damage resulBng from secondary injury
processes such as lipid peroxidaBon