General measures

• Carefully monitor neurological function to enable early detection of spinal cord compression and referral for urgent remedial surgery.

• Give LMW heparin SC for thromboembolism prophylaxis.

• The incidence of stress ulceration is high. Ideally, enteral nutrition should be instituted at an early stage though this may prove unsuccessful. Drugs (e.g. sucralfate, H2 blockers) may be needed.

• Enteral feeding may be difficult to institute initially as gastric distension and paralytic ileus is common following spinal cord injury. A NG tube should be inserted for gastric decompression. An enterostomy may eventually be needed to enable long-term feeding.

• Bowel and bladder function may be deranged. Long-term silastic bladder catheters and regular laxative and enema therapy should be instituted at an early stage.

• Special care is needed to prevent pressure sores.

• Institute regular exercises to prevent contractures.

• Psychological support for patient and family is crucial, particularly if long-term disability is likely.

• High-dose steroid therapy may be beneficial if started within 8h, though this still remains controversial.

• Hyperbaric oxygen therapy is of unproved benefit.

• After spinal injury, muscle relaxants may cause severe hyperkalaemia.

• Steroids have been shown to be useful but this remains controversial.

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