METI~ Spinal Cord Injured Patient with Neurogenic Shock

History/Information:
The patient, a 20-year-old male, was a crew member on a construction team building a house when he slipped and
tripped on building materials and fell 30 feet from the roof. The patient hit the ground with a thud and his co-workers
went running to his aid and called emergency medical services (EMS). The patient was moaning and conversing with
one of his buddies who continuously reminded him to be still and not to try and move. EMS arrived on the scene
and found the patient alert and oriented and immediately stabilized his neck with a rigid cervical collar. At the scene,
the patient stated that he could not feel or move either of his legs and that his left hand felt numb and tingly. Initial
history and physical at the scene found that the patient was a normal, healthy young adult male with no previous
health history; respiratory rate and effort adequate, pulses palpable and strong in all four extremities, skin warm and
color normal with brisk capillary refill, left arm painful to slight touch, and fine motor movement adequate (able to
wiggle fingers). Paresthesia and no movement was noted in bilateral lower extremities. His initial vital signs at the
scene were reported to be: HR 92, BP 128/86, RR 28, and SpO, 94%. The diagnosis of suspected spinal cord injury
was made and methylprednisolone loading dose of 30mg/kg was initiated. Report was called to the local hospital
Emergency Department (ED) and the patient was placed on a backboard and transported with no difficulties. Upon
arrival to the hospital, the emergency medicine healthcare provider quickly assessed the patient and determined
that he was hemodynamically stable and that he should be emergently transferred to the regional spinal cord injury
center for specialized medical care.
Learning Objectives:
1. Utilizes the patient history and assessment data to plan, prioritize, individualize and provide care for a person with
a spinal cord injury that develops neurogenic shock (SYNTHESIS).
2. Anticipates diagnostic orders and therapies, including medications, for the patient with neurogenic shock
(COMPREHENSION).
3. Discusses the possible consequences of unrecognized neurogenic shock (COMPREHENSION).
4. Prioritizes the implementation and approach to the nursing care of a patient in neurogenic shock (ANALYSIS).
5. Evaluates the patient's response to interventions and modifies the nursing care as appropriate for the patient in
neurogenic shock (EVALUATION)

Continuous ECG and SpO, monitoring

Vital signs and neurological assessment every 1 hour
Oxygen 2LPM via nasal canula; titrate to keep SpO, greater than 95%
Incentive spirometer every hour while awake
Cough and deep breathe every hour while awake
NPO
CBC with differential, Electrolytes, BUN Creatinine, Glucose, ABG on
arrival and every AM
CT scan with contrast of the spine
X-ray of left arm and shoulder
Chest x-rayon admission and every other AM
IV 0.9% NS at 80mLlhour
Methylprednisolone 5.4mg/kg continuous IV infusion for 24 hours
Strict bed rest; maintain spinal alignment, log roll only
Rigid cervical collar
Antiembolic stockings and sequential compression device for deep vein
thrombosis (DVT) prophylaxis
Famotidine 20mg IV twice daily
Morphine sulfate 1-2mg IV every 1 hour prn for pain
Notify healthcare provider for:
HR greater than 140 or less than 60
Systolic BP less than 90 or greater than 180
Temp greater than 38C
Sp02 less than 92%
Urine output less than 30mUhour x 2 hours
Any neurologic changes

Bader, M. K. and Littlejohns, L R. (2004). MNN

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3. Describe the lab and diagnostic tests that would be anticipated for a patient admitted
with a spinal cord injury.

core curriculum for neuroscience

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Hickey, J. V. (2003). The clinical practice of neurological and neurosurgical
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Hodges, R., Garrett, K., Chernecky, C. and Schumacher, L. (2005). Real-world
nursing survival guide: Hemodynamic monitoring. Philadelphia: Saunders.

7. Identify three nursing diagnoses for the patient with spinal cord injury focusing on the
first 24 hours in the ICU.

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Schumacher, L. and George-Gay, B. (2002). Spinal cord injury. In George-Gay, B.,
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to critical care

Springhouse. (2007). Best practices: A guide to excellence in nursing care (2nd

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