Spinal cord injury: acute care management.

This article has been subjected to double blind peer review The first two articles in this series described the anatomy and physiology of the vertebral column and spinal cord, and examined the aetiology and pathophysiology of spinal cord injuries (Sheerin 2004, 2005). These provide a basis for understanding the presentation and management of spinal cord injuries. It is difficult to be prescriptive about care because spinal cord injuries can present in various ways. Sensory and motor loss can be total below the injury level, perhaps involving segments S4 and S5, or there may be varying degrees, and indeed types, of neurological loss, with sacral function remaining (Sheerin 2005). Good initial and acute management is crucial however, whatever the degree of damage (Campagnolo and Heary 2002, Sheerin and Gillick 2004). This article, therefore, focuses on the principles of acute care for patients with suspected or confirmed cervical spinal cord injuries before admission to specialised spinal units. Care of those patients with lower, less widespread spinal cord injuries may be extrapolated from this.