ACUTE SPINAL CORD injuries include fractures, contusions, and compressions of the vertebral column, usually from trauma. Spinal fractures most commonly occur in the 5th, 6th, and 7th cervical; 12th thoracic; and 1st lumbar vertebrae. The most serious consequence of any spinal injury is spinal cord damage, which can lead to paralysis or death.

Most serious spinal cord injuries result from motor vehicle crashes, falls from great heights, diving into shallow water, and gunshot wounds; less serious injuries result from lifting heavy objects and minor falls.

If you suspect your patient has a spinal cord injury, limit the extent of the injury with immobilization and administer steroids and other medications as ordered. Take actions to prevent complications that may occur as a result of the injury. Possible complications include respiratory dysfunction, neurogenic shock, ascending spinal cord edema, autonomic dysreflexia, and venous thromboembolism. Accurately document all assessment findings and nursing interventions to guide ongoing care and treatment decisions.

Document measures taken to immobilize the patient's spine and interventions taken to maintain airway patency and respirations. Document a baseline neurologic assessment and the results of your other systems assessments (for example, cardiovascular). Record your interventions, such as administering drugs, maintaining spinal immobilization, positioning and logrolling the patient, or assisting with preparing him for neurosurgery.

Document your patient's responses to interventions. Use flow sheets to record ongoing neurologic assessment findings, vital signs, intake and output, I.V. therapy, and lab test values. Include any patient teaching and emotional support you provide to the patient and his family.