Respiratory Management Following Spinal Cord Injury - 8

8

RESPIRATORY MANAGEMENT FOLLOWING SPINAL CORD INJURY

Recommendations
Initial Assessment of Acute SCI
1. Guide the initial management of people presenting with suspected or possible spinal cord injury in the field and in the emergency department using American Heart Association and American College of Surgeons principles of basic life support, advanced cardiac life support, and advanced trauma life support.
(Scientific evidence–V; Grade of recommendation–C; Strength of panel opinion–Strong)

Conduct periodic assessments of respiratory function to include: Respiratory complaints. Physical examination of the respiratory system. Chest imaging as indicated. Continuous pulse oximetry. Performance of the respiratory muscles: vital capacity (VC) and maximal negative inspiratory pressure. Forced expiratory volume in 1 second (FEV1) or peak cough flow. Neurological level and extent of impairment.
(Scientific evidence–NA; Grade of recommendation–NA; Strength of panel opinion–Strong)

Guidelines from the American Heart Association and the American College of Surgeons suggest the professional standard for emergency care of respiratory and cardiovascular emergencies. The guidelines are evidence based and are regularly reviewed and changed as warranted. They apply to the needs of spinal cord injured individuals during the emergency and urgent phases of care. 2. Perform an initial history and physical exam to include the following: Relevant past medical history. Prior history of lung disease. Current medications. Substance abuse. Neurologic impairment. Coexisting injuries.
(Scientific evidence–NA; Grade of recommendation–NA; Strength of panel opinion–Strong) Note: See Recommendation 3 Rationale.

3. The initial laboratory assessment should include: Arterial blood gases. Routine laboratory studies (complete blood count, chemistry panel, coagulation profile, cardiac enzyme profile, urinalysis, toxicology screen). Chest x-ray. EKG.

Pulmonary problems are a common comorbidity of spinal cord injury, especially among cervical and higher thoracic injuries. Clinical assessment, including respiratory rate and pattern, patient complaints, chest auscultation, and percussion, significantly contributes to the initial and ongoing management of people with higher spinal cord injuries. Objective, reproducible measures of pulmonary mechanics should document all sequential trends in respiratory function. By following these parameters closely, new deficits in function can be identified and treated in a controlled fashion before they become clinically urgent. In the hours and days after injury, the neurological level of injury can ascend, causing changes in respiratory function requiring urgent attention. In addition, people with high-level cervical injuries (C3–5) may fatigue over the course of the first few days after their injury, especially since they are unable to cough up their secretions. Common methods of evaluation, such as chest roentgenograms (x-rays), have been shown to miss significant respiratory pathologies and cannot be relied on as the sole evidence of normal function. Nevertheless, chest x-rays provide useful diagnostic information when pathology is identified. 4. Monitor oxygen saturation and end tidal CO2 to measure the quality of gas exchange during the first several days after injury in correlation with patient expression of respiratory distress.
(Scientific evidence–NA; Grade of recommendation–NA; Strength of panel opinion–Strong)
Respiratory Management Following Spinal Cord Injury

Table of Contents for the Digital Edition of Respiratory Management Following Spinal Cord Injury
