Patho Physiology

Individuals with cervical spinal cord injury often have physiological bradycardia (pulse, 45-60 and Hypotension (80-90 systolic). This is related to loss of sympathetic tone and a relative increase in vagal activity on the heart.

In the absence of clearly established and significant blood loss, any fluid replacement should be moderate and attempt should not be made to correct the physiological hypovolaemia. Indiscriminate administration of intravenous fluid could result in precipitous respiratory embarrassment from pulmonary congestion/oedema.

Extremities are often warm with a good volume pulse in tetraplegic patients seen in the A & E Departments in spite of bradycardia and hypotension.

Previously fit tetraplegic patients usually maintain their oxygen saturation unless the injury is above the level of C5. Ventilatory difficulties however can occur during the acute phase due to cord oedema/bleed etc. Close monitoring of O2 saturation will be essential.

Bowel sounds may be present during initial assessment in the A & E Department but they usually disappear during the subsequent 4-8 hours It is therefore advisable not to administer significant volumes of oral fluids for the first 24-48 hours.

Paralysed skin over bony prominences cannot withstand sustained pressure. Prolonged stay on a stretcher/hard objects inevitably results in significant tissue damage that is often difficult to heal and contributes to a considerable increase in hospital stay.

Tetraplegic patients are poikilo-thermic with a tendency to lose body heat rapidly. Suitable shielding from the environment to reduce heat loss is essential. Any attempt at warming should be gradual and should not include placing warm bottles over insensate skin.