Spinal cord injury involves the immediate or delayed life-threatening. It is the cause of motor and sensory disorders, and disorders of autonomic functions. Routine medicalization and progress taking pre-hospital care have greatly improved the survival of these injuries.
To write a descent research paper on spinal cord injury you should know that the evolution of knowledge, especially in the pathophysiology of cell damage, regularly offers new therapeutic attitudes, sometimes controversial.
A patient with a spinal cord injury is extremely fragile, especially in the initial phase. It fully justifies specialized care. The combined efforts and specialized services after a stay in intensive care,should make possible the patient transfer to a rehabilitation with respiratory autonomy recovered of a stable spine, and the potential for full recovery.
If specific medical treatments such as methylprednisolone open a rich channel of hope, the simple general principles of the medical management of these patients are not be neglected: good oxygenation, good spinal cord infusion.
Trauma when the soft osteo-disco-ligamentous thoracic or lumbar spinal structure is injured to the point of jeopardizing the integrity of its content is regarded as violent and related organ damage or devices are common. All combinations are possible. Neck injury may be associated with lesions of the face and scalp. Injuries of the thoracic spine are frequently accompanied by hemothorax (one third of cases, bilateral half the time), pneumothorax and flail chest, or visceral lesions especially the spleen. Such injuries pose a significant risk to life, especially when spinal emergency surgery, and mortality of the thoracic spine trauma is not zero. The benefit/risk of emergency surgery is very carefully considered, particularly in the case of neurological disorders. Particularly common in the case of chest trauma, associated lesions are searched and processed according to their urgency. A discussion between specialist surgeon, anesthetist and radiologist is needed to establish the hierarchy of the severity of injuries and their treatment. Associated lesions, their hemodynamic consequences and the oxygenation may themselves aggravate spinal cord injury.
A high risk of pulmonary embolism is very common in patients with spinal cord trauma. Its systematic prevention is by low molecular weight heparin from the hours following the trauma.
The nutrition in spinal cord trauma in its highest forms is necessary to support the fight against malnutrition, infections, poor wound healing, and the danger of the mesenteric artery syndrome. However, the recovery of food intake is hampered by the arrest of transit that occurs usually in the days following the trauma. The parenteral nutrition is to be started within 24-48 hours after spinal cord injury, quickly supplemented by enteral and later oral, reaching levels of about 2000-2500 kcal.
Extremely frequent complication in spinal cord trauma is caused by an indwelling catheter, in fact it s rarely an issue during the initial phase of the treatment. If antibiotic therapy is initiated, it shall be slightly mutagenic, to prevent the emergence of multi-resistant bacteria. The practice of repeat tube insertion remains to be evaluate in this emergency setting.
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