Management of Multi-system Disability

Cardio-vascular system

In tetraplegic patients physiological bradycardia and hypotension is common. In the absence of clear evidence of blood loss due to other injuries, it is recommended that the fluid replacement be limited to estimated fluid loss. In general a 70 kilogram male with no additional fluid loss is likely to need between 2.0 – 2.5 litres of fluid over a 24-hour period. NOTE: Urine output is usually low during the first 24-48 hours.

Central venous pressure is not likely to be a reliable guide to the state of perfusion of a paralysed individual (due to autonomic disturbance).

Atropine 0.3 – 0.6mg should be administered if the pulse rate drops below 45 per minute and repeated as needed.

Unless there are specific contraindications due to other systemic illness, all patients with spinal cord injury should receive low monocular weight Heparin and/or oral anticoagulants. Liver function tests may be necessary. INR of between 2-3 is adequate in patients with spinal cord injury to prevent DVT/PE.