Spinal Cord Injury Patients

Infections:
SCI is an important population as their re-admit rate is 50% in the 1st year of injury and 37% annually therafter
Location of lesion and subsequent deficits determines their risk ie) cervical and hi thoracic lesions impair diaphragm and inc risk of respiratory compromise
UTI, PNA and skin ulcers are the most common cause of infection in SCI
UTI-incidence is 2.5 cases/pt/yr and increases with indwelling foleys and assisted intermittent catheterization; self-cath appears to be lower risk than other forms of cath and should be utilized to maintain post-void residuals <500cc

Underlying etiolgy is due to increased risk of neurogenic bladder but they may also have ureteral reflux and stones
PNA- Pulmonary infection is due to respiratory mm weakness, impaired cough and poor secretion clearance. Chest PT and incentive spirometry (to facilitate deep breathing) are recommended. Patients unable to hyperventilate as compensatory mechanism and should be monitored closely with first sign resp infection or compromise
Skin Ulcers- most common cause of sepsis in this population. Good skin hygeine and close monitoring recommended

Hemodynamics:
Baseline Hypotension:

Patients often have bradycardia (50-60s) and may have low blood pressure chronically. Orthostasis common within months of injury as peripheral tone adjusts to altered neurologic input
Sporadic HypERtension: Autonomic Dysreflexia is a hypersensitivity to noxious stimuli causing hypertension often with SBP>200, which is treated by removing the stimuli. Most common causes are GU manipulations (foley clogged) and severe constipation/impaction. Avoid antihtn as they may cause extreme hypotension when insult is removed. If pt with end organ damage and HTN emergency, use short-acting antihtn like nitrate, hydralazine.
Note that SCI pt's have 3-10 fold risk of CAD due to overweight, immobility and may be at high risk for cardiac ischemia!

(Ellen Eaton MD, 9/23/10)