Respiratory system

Tetraplegic patients rely exclusively on their diaphragm for respiration. It is therefore important to avoid respiratory infection by regular and period chest physiotherapy (deep breathing exercise, vibration, percussion and postural drainage).

In these patients, any co-existing rib fractures, haemothorax, pneumothorax will significantly reduce their respiratory function.

It is advisable to document respiratory frequency, oxygen saturation, and vital capacity on a regular basis at least for the first 48-72 hours.

Patients with spinal cord injury at C5 or above have the potential to develop a gradual deterioration of their respiratory function due to spinal cord oedema, intra-spinal haematoma etc. during the first 72 hours of injury. In these patients regular monitoring of pH , pCO2 and neurological level will help to determine the need for assisted ventilation.

Placement of chest tubes either to drain a pneumothorax or a haemothorax should take into account the fact that the paralysed patient may be confined to bed for several weeks and nursing needs demand regular turns. It is therefore essential to place chest drain tubes more anteriorly.