l. A patient with only a head injury should be fluid restricted to decrease
m. Anticonvulsants may be required.
n. Document carefully. Describe the patient's condition in terms of
responsiveness to the environment.
Avoid words such as lethargic, semiconscious, obtunded (to diminish pain or
to diminish touch sensation).
Section II. SPINAL CORD INJURY
5-11. GENERAL INFORMATION
a. Approximately 10,000 people suffer spinal cord injuries each year in the
United States. Most of these injuries are caused by instability of the vertebral column
following trauma. A spinal cord injury can be devastating to the patient in many ways.
b. The spinal cord has two major functions. First, it is a two-way conductor
pathway between the brain stem and the peripheral nervous system. Second, the
spinal cord is a reflex center for all spinal reflexes. A large number of messages to and
from the brain are sent through the spinal cord -- the pathway function. In its reflex
capacity, the spinal cord allows us to react quickly to such things as pain and too much
heat without the time involved in the brain having to send orders.
c. Damage to the spinal cord may isolate a part of the body from the brain. The
patient may have a complete injury, losing all conscious motor and sensory function
below the injury. Or, he may have an incomplete injury, retaining some motor or
sensory function. Many injuries to the spine result in ligament sprains or nondisplaced
fractures. Such injuries heal well and have an excellent prognosis. Displaced fractures
or dislocations of the spine can damage the spinal cord or the nerve roots resulting in
permanent paralysis or death.
d. The healing power of spinal cord nerve tissue is limited. If spinal cord nerve
tissue is damaged to a certain point, that nerve tissue will not heal. The patient will
have a loss of function that cannot be restored.
e. The goal of initial care of a patient with a possible spinal cord injury is to keep
further injury from occurring. Specifically, you want to prevent additional damage to the
brain, the spinal cord, and the major nerves of the body. In many cases, the care first
given to such a patient determines whether he regains normal function of his body or is
crippled for the rest of his life.