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CDHB

Common Presentations of Non-Acute/Long-term Spinal Cord Injury Patients

Respiratory Infections

Assessment

• Arterial blood gas essential.
• Sat.O₂ alone is inadequate.
• Chest X-ray.

Treatment

• Assistance with coughing in order to clear secretions and obtain sputum. Get Physiotherapist involvement as patient may not be able to cough.
• Antibiotics and oxygen if indicated.
• Care of skin is critical. Ensure patient is turned regularly.

Urinary Tract Infections

Assessment

• Urine for culture: bag urine not recommended, so bladder puncture for microscopy and culture will be needed.
• May need bladder catheterization and anticholinergic drugs.
• If urinary tract stones are likely, consider plain X-ray (KUB) for kidney, ureter and bladder. This is more likely if the patient has autonomic dysreflexia. Discuss with the Consultant if you think ultrasound is indicated.

Treatment

• Prescribe antibiotics.
• If tetraplegic, exclude an upper respiratory tract infection.

Lost Suprapubic Catheter Tract

If a spinal cord injury patient, who has had a suprapubic catheter placed for bladder management, has sluggish urinary drainage, or the suprapubic catheter comes out accidentally:

• Check for a urinary infection.
• Give antibiotics according to any recent cultures/sensitivities. If no cultures available on admission, give amoxicillin 1 g IV, and gentamicin 160 mg IV, both stat, before the insertion of a urethral catheter.
• Insert urethral catheter to allow bladder drainage.
• If not already taking an anticholinergic drug, give oxybutynin 5 mg BO PO.
• Call the Urology Registrar urgently (they may be able to reinsert the suprapubic catheter).

Constipation - with or without Abdominal Distension

Assessment

• Ask patient or caregiver to describe the bowel pattern for the last few days.
• Plain abdominal X-ray to exclude obstruction volvulus. May require CT abdomen.
• May be secondary to medications. Exclude a urinary tract infection.

Treatment

• Consider a gentle enema. Review drug treatment.

Contact the on-call Spinal Consultant via the hospital operator if there any questions on management.

Topic Code: 72661