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Ongoing management of the tetraplegic patient in the ICU 

Ongoing management of the tetraplegic patient in the ICU
Chapter:
Ongoing management of the tetraplegic patient in the ICU
Author(s):

Oliver Flower

and Raymond Raper

DOI:
10.1093/med/9780199600830.003.0345
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date: 22 February 2020

This chapter focuses on the intensive care management of patients who have suffered cervical spinal cord injury (CSCI). This includes new CSCI, following initial resuscitation and stabilization, and the common issues faced when managing longstanding tetraplegic patients who require critical care. For patients with a new diagnosis of CSCI, a comprehensive systems-based approach is suggested covering topics including terminology, the standardized neurological examination, muscle spasticity, neuropathic pain, venous thromboembolism prophylaxis, as well as renal, gastrointestinal, and pressure care considerations. Particular attention should be paid to respiratory care, including ventilation strategies, tracheostomy, and the management of respiratory complications. The importance of early rehabilitation and appropriate psychosocial support is discussed. Common critical care issues affecting patients with chronic tetraplegia include autonomic dysreflexia, respiratory failure, peri-operative care, sepsis and complications of indwelling intrathecal devices.

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