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Emergencies and Acute Care in Chronic Spinal Cord Injury Patients

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A Practical Guide to Care of Spinal Cord Injuries

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Abstract

This chapter focuses on the critical issue of acute medical complications in patients with chronic spinal cord injuries. The chapter highlights the fact that these patients are prone to sudden medical problems and emergency situations due to their injury, which can have a substantial impact on their quality of life and functional independence. The importance of preventing, early diagnosing, and effectively treating these complications cannot be overemphasized as it can improve the patient’s survival, community participation, and overall health-related quality of life. The text recognizes that patients with chronic spinal cord injuries may have altered or absent sensations below their level of injury, making it challenging to recognize medical emergencies in a timely manner. This chapter provides practical guidance on how to manage and respond to these acute complications in patients with chronic spinal cord injuries, drawing upon information discussed in previous chapters. It is designed to aid clinicians and caregivers in delivering the optimal care to their patients with chronic spinal cord injuries. The chapter covers a range of topics, including early recognition of acute medical complications, appropriate response, and emergency management strategies for patients with chronic spinal cord injuries.

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References

  • Amsterdam EA, Kirk JD, Bluemke DA, et al. Testing of low-risk patients presenting to the emergency department with chest pain: a scientific statement from the American Heart Association. Circulation. 2010;122:1756–76.

    Article  PubMed  PubMed Central  Google Scholar 

  • Apstein MD, Dalecki-Chippenfield K. Spinal cord injury is a risk factor for gallstone disease. Gastroenterology. 1987;92:966–8.

    Article  CAS  PubMed  Google Scholar 

  • Blackmer J. Rehabilitation medicine: 1. Autonomic dysreflexia. CMAJ. 2003;169:931–5.

    PubMed  PubMed Central  Google Scholar 

  • Cao Y, Massaro JF, Krause JS, et al. Suicide mortality after spinal cord injury in the United States: injury cohorts analysis. Arch Phys Med Rehabil. 2014;95:230–5.

    Article  PubMed  Google Scholar 

  • Charney KJ, Juler GL, Comarr AE. General surgery problems in patients with spinal cord injuries. Arch Surg. 1975;110:1083–8.

    Article  CAS  PubMed  Google Scholar 

  • Claydon VE, Krassioukov AV. Orthostatic hypotension and autonomic pathways after spinal cord injury. J Neurotrauma. 2006;23:1713–25.

    Article  PubMed  Google Scholar 

  • Consortium for Spinal Cord Medicine. Acute management of autonomic dysreflexia: individuals with spinal cord injury presenting to health care facilities. 2nd ed. Washington, DC: Paralyzed Veterans of America; 2001.

    Google Scholar 

  • Cruz ES, Stolzenberg D, Moon D. Medical emergencies in rehabilitation medicine. In: Maitin IB, editor. Current diagnosis and treatment: physical medicine and rehabilitation. New York: McGraw-Hill Education; 2015.

    Google Scholar 

  • Dubbs SB, Sommerkamp SK. Evaluation and management of urinary tract infection in the emergency department. Emerg Med Clin North Am. 2019;37:707–23.

    Article  PubMed  Google Scholar 

  • El Masri WE, Cochrane P, Silver JR. Gastrointestinal bleeding in patients with acute spinal injuries. Injury. 1982;14:162–7.

    Article  PubMed  Google Scholar 

  • Frank RG, Chaney JM, Clay DL, et al. Dysphoria: a major symptom factor in persons with disability or chronic illness. Psychiatry Res. 1992;43:231–41.

    Article  CAS  PubMed  Google Scholar 

  • Friesbie JH. Fractures after myelopathy: the risk quantified. J Spinal Cord Med. 1997;20:66–9.

    Article  Google Scholar 

  • Fuhrer MJ, Rintala DH, Hart KA, et al. Depressive symptomatology in persons with spinal cord injury who reside in the community. Arch Phys Med Rehabil. 1993;74:255–60.

    Article  CAS  PubMed  Google Scholar 

  • Furlan JC, Kattail D, Fehlings MG. The impact of comorbidities on age-related differences in mortality after acute traumatic spinal cord injury. J Neurotrauma. 2009;26:1361–7.

    Article  PubMed  Google Scholar 

  • Gibbons CH, Schmidt P, Biaggioni I, et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. J Neurol. 2017;264:1567–82.

    Article  PubMed  PubMed Central  Google Scholar 

  • Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:e103–20.

    Article  PubMed  Google Scholar 

  • Hagen EM, Rekand T, Grønning M, et al. Cardiovascular complications of spinal cord injury. Tidsskr Nor Laegeforen. 2012;132:1115–20.

    Article  PubMed  Google Scholar 

  • Hartkopp A, Brønnum-Hansen H, Seidenschnur AM, et al. Suicide in a spinal cord injured population: its relation to functional status. Arch Phys Med Rehabil. 1998;79:1356–61.

    Article  CAS  PubMed  Google Scholar 

  • Imam T. Bacterial urinary tract infections. Merk manual. 2021. https://www.merckmanuals.com/professional/genitourinary-disorders/urinary-tract-infections-utis/bacterial-urinary-tract-infections?redirectid=149. Accessed 2 Oct 2022.

  • Juler GL, Eltorai IM. The acute abdomen in spinal cord injury patients. Paraplegia. 1985;23:1118–23.

    Google Scholar 

  • Ketover SR, Ansel HJ, Goldish G, et al. Gallstones in chronic spinal cord injury: is impaired gallbladder emptying a risk factor? Arch Phys Med Rehabil. 1996;77:1136–8.

    Article  CAS  PubMed  Google Scholar 

  • Khan MF, Burks SS, Al-Khayat H, et al. The effect of steroids on the incidence of gastrointestinal hemorrhage after spinal cord injury: a case-controlled study. Spinal Cord. 2014;52:58–60.

    Article  CAS  PubMed  Google Scholar 

  • Kiwerski J. Bleeding from the alimentary canal during the management of spinal cord injury patients. Paraplegia. 1986;24:92–6.

    CAS  PubMed  Google Scholar 

  • Krassioukov A, Eng JJ, Warburton DE, et al. A systematic review of the management of orthostatic hypotension after spinal cord injury. Arch Phys Med Rehabil. 2009;90:876–85.

    Article  PubMed  PubMed Central  Google Scholar 

  • Krysinska K, Lester D, Martin G. Suicidal behavior after a traumatic event. J Trauma Nurs. 2009;16:103–10.

    Article  PubMed  Google Scholar 

  • Kupfer M, Kucer BT, Kupfer H, et al. Persons with chronic spinal cord injuries in the emergency department: a review of a unique population. J Emerg Med. 2018;55:206–12.

    Article  PubMed  Google Scholar 

  • Lamarre-ClichĂ© M. Drug treatment of orthostatic hypotension because of autonomic failure or neurocardiogenic syncope. Am J Cardiovasc Drugs. 2002;2:23–35.

    Article  PubMed  Google Scholar 

  • Leramo OB, Tator CH, Hudson AR. Massive gastroduodenal hemorrhage and perforation in acute spinal cord injury. Surg Neurol. 1982;17:186–90.

    Article  CAS  PubMed  Google Scholar 

  • McKinley WO, Jackson AB, Cardenas DD, et al. Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil. 1999;80:1402–10.

    Article  CAS  PubMed  Google Scholar 

  • Miller BJ, Geraghty TJ, Wong CH, et al. Outcome of the acute abdomen in patients with previous spinal cord injury. ANZ J Surg. 2001;71:407–11.

    Article  CAS  PubMed  Google Scholar 

  • Moonka R, Stiens SA, Resnick WJ, et al. The prevalence and natural history of gallstones in spinal cord injured patients. J Am Coll Surg. 1999;189:274–81.

    Article  CAS  PubMed  Google Scholar 

  • Morris LL, Whitmer A, McIntosh E. Tracheostomy care and complications in the intensive care unit. Crit Care Nurse. 2013;33:18–30.

    Article  PubMed  Google Scholar 

  • Nam HS, Kim HR, Ha TH, et al. Suicidal ideation in Korean persons with spinal cord injury. Spinal Cord. 2013;51:789–93.

    Article  CAS  PubMed  Google Scholar 

  • National Spinal Cord Injury Statistical Center (NSCISC). Complete public version of the 2020 annual statistical report for the spinal cord injury model systems. 2021. https://www.nscisc.uab.edu/public/2020%20Annual%20Report%20-%20Complete%20Public%20Version.pdf. Accessed 25 Aug 2021.

  • Nawrocki O, Hughart J, Morgenstern J. Tracheostomy emergencies. Emerg Med Rep. 2021. https://www.reliasmedia.com/articles/148186-tracheostomy-emergencies. Accessed 2 Oct 2022.

  • Neumayer LA, Bull DA, Mohr JD, et al. The acutely affected abdomen in paraplegic spinal cord injury patients. Ann Surg. 1990;212:561–6.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Nobunaga AI. Orthostatic hypotension in spinal cord injury. Top Spinal Cord Inj Rehabil. 1998;4:73–80.

    Article  Google Scholar 

  • Norwood BS. Common laboratory abnormalities. In: Cardenas DD, Hooton TM, editors. Medical complications in physical medicine and rehabilitation. New York: Demos Medical Publishing; 2015.

    Google Scholar 

  • O’Connor H, White A. Tracheostomy decannulation. Respir Care. 2010;55:1076–81.

    PubMed  Google Scholar 

  • Okamoto LE, Diedrich A, Baudenbacher FJ, et al. Efficacy of servo-controlled splanchnic venous compression in the treatment of orthostatic hypotension: a randomized comparison with midodrine. Hypertension. 2016;68:418–26.

    Article  CAS  PubMed  Google Scholar 

  • Ong B, Wilson JR, Henzel MK. Management of the patient with chronic spinal cord injury. Med Clin North Am. 2020;104:263–78.

    Article  PubMed  Google Scholar 

  • Patros C, Sabol M, Paniagua A, et al. Implementation and evaluation of an algorithm-based order set for the outpatient treatment of urinary tract infections in the spinal cord injury population in a VA Medical Center. J Spinal Cord Med. 2018;41:192–8.

    Article  PubMed  Google Scholar 

  • Pattanong P. Dislodged tracheostomy. J Prapokklao Hosp Clin Med Educat Center. 2007;24:304–8.

    Google Scholar 

  • Phillips WT, Kiratli BJ, Sarkarati M, et al. Effect of spinal cord injury on the heart and cardiovascular fitness. Curr Probl Cardiol. 1998;23:641–716.

    Article  CAS  PubMed  Google Scholar 

  • Regan K, Hunt K. Tracheostomy management. Contin Educ Anaesth Crit Care Pain. 2008;8:31–5.

    Article  Google Scholar 

  • Rotter KO, Larrain CG. Gallstones in spinal cord injury (SCI): a late medical complication? Spinal Cord. 2003;41:105–8.

    Article  CAS  PubMed  Google Scholar 

  • Sezer N, AkkuÅŸ S, UÄŸurlu FG. Chronic complications of spinal cord injury. World J Orthop. 2015;6:24–33.

    Article  PubMed  PubMed Central  Google Scholar 

  • Shergill IS, Arya M, Hamid R, et al. The importance of autonomic dysreflexia to the urologist. BJU Int. 2004;93:923–6.

    Article  CAS  PubMed  Google Scholar 

  • Sidorov EV, Townson AF, Dvorak MF, et al. Orthostatic hypotension in the first month following acute spinal cord injury. Spinal Cord. 2008;46:65–9.

    Article  CAS  PubMed  Google Scholar 

  • Solerstrom CA, Ducker TB. Increased susceptibility of patients with cervical cord lesions to peptic gastrointestinal complications. J Trauma. 1985;25:1030–8.

    Google Scholar 

  • Stolarski A, He K, Whang E, et al. Diagnostic challenges of acute abdominal emergencies in spinal cord injury patients: a clinical perspective. J Sure Open Access. 2020;6(4). https://doi.org/10.16966/2470-0991.215.

  • Tandon RK, Jain RK, Garg PK. Increased incidence of biliary sludge and normal gall bladder contractility in patients with high spinal cord injury. Gut. 1997;41:682–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Vaidyanathan S, Soni B, Oo T, et al. Autonomic dysreflexia in a tetraplegic patient due to a blocked urethral catheter: spinal cord injury patients with lesions above T-6 require prompt treatment of an obstructed urinary catheter to prevent life-threatening complications of autonomic dysreflexia. Int J Emerg Med. 2012;5:6.

    Article  PubMed  PubMed Central  Google Scholar 

  • Walters K, Silver JR. Gastrointestinal bleeding in patients with acute spinal injuries. Int Rehabil Med. 1986;8:44–7.

    CAS  PubMed  Google Scholar 

  • Yee AH, Rabinstein AA. Neurologic presentations of acid-base imbalance, electrolyte abnormalities, and endocrine emergencies. Neurol Clin. 2010;28:1–16.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Parkside Rehabilitation Hospital, Busan, Korea (Republic of)

    Hyun-Yoon Ko

  2. Department of Rehabilitation Medicine, Pusan National University College of Medicine, Yangsan, Korea (Republic of)

    Hyun-Yoon Ko

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  1. Hyun-Yoon Ko
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© 2023 The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.

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Ko, HY. (2023). Emergencies and Acute Care in Chronic Spinal Cord Injury Patients. In: A Practical Guide to Care of Spinal Cord Injuries. Springer, Singapore. https://doi.org/10.1007/978-981-99-4542-9_42

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  • DOI: https://doi.org/10.1007/978-981-99-4542-9_42

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  • Publisher Name: Springer, Singapore

  • Print ISBN: 978-981-99-4541-2

  • Online ISBN: 978-981-99-4542-9

  • eBook Packages: MedicineMedicine (R0)

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