Tài liệu ABC of Spinal Cord Injury pdf

ABC OF

SPINAL CORD

INJURY: Fourth edition

BMJ Books

ABC OF

SPINAL CORD INJURY

ABC OF

SPINAL CORD INJURY

Fourth edition

Edited by

DAVID GRUNDY

Honorary Consultant in Spinal Injuries,

The Duke of Cornwall

Spinal Treatment Centre,

Salisbury District Hospital, UK

ANDREW SWAIN

Clinical Director, Emergency Department,

MidCentral Health, Palmerston Hospital North,

New Zealand

©BMJ Books 2002

BMJ Books is an imprint of the BMJ Publishing Group

BMJ Publishing Group 1986, 1993, 1996

All rights reserved. No part of this publication may be reproduced,

stored in a retrieval system, or transmitted, in any form or by any

means, electronic, mechanical, photocopying, recording and/or

otherwise, without the prior written permission of the publishers.

First published 1986

Reprinted 1989

Reprinted 1990

Reprinted 1991

Second edition 1993

Reprinted 1994

Third edition 1996

Reprinted 2000

Fourth edition 2002

by the BMJ Publishing Group, BMA House, Tavistock Square,

London WC1H 9JR

British Library Cataloguing in Publication Data

A catalogue record for this book is available from the British Library

ISBN 0-7279-1518-5

Typeset by Newgen Imaging Systems (P) Ltd., Chennai, India

Printed in Malaysia by Times Offset

Cover image: Lumbar spine. Coloured x ray of four lumbar

vertebrae of the human spine, seen in antero-posterior view.

Reproduced with permission from Science Photo Library.

v

Contents

Contributors vi

Preface vii

1 At the accident 1

ANDREW SWAIN, and DAVID GRUNDY

2 Evacuation and initial management at hospital 5

ANDREW SWAIN, and DAVID GRUNDY

3 Radiological investigations 11

DAVID GRUNDY, ANDREW SWAIN, and ANDREW MORRIS

4Early management and complications—I 17

DAVID GRUNDY, and ANDREW SWAIN

5 Early management and complications—II 21

DAVID GRUNDY, and ANDREW SWAIN

6 Medical management in the spinal injuries unit 25

DAVID GRUNDY, ANTHONY TROMANS, JOHN CARVELL, and FIRAS JAMIL

7 Urological management 33

PETER GUY, and DAVID GRUNDY

8 Nursing 41

CATRIONA WOOD, ELIZABETH BINKS, and DAVID GRUNDY

9 Physiotherapy 49

TRUDY WARD, and DAVID GRUNDY

10 Occupational therapy 53

SUE COX MARTIN, and DAVID GRUNDY

11 Social needs of patient and family 57

JULIA INGRAM, and DAVID GRUNDY

12 Transfer of care from hospital to community 60

RACHEL STOWELL, WENDY PICKARD, and DAVID GRUNDY

13 Later management and complications—I 65

DAVID GRUNDY, ANTHONY TROMANS, and FIRAS JAMIL

14Later management and complications—II 70

DAVID GRUNDY, ANTHONY TROMANS, JOHN HOBBY, NIGEL NORTH, and IAN SWAIN

15 Spinal cord injury in the developing world 76

ANBA SOOPRAMANIEN and DAVID GRUNDY

Index 81

vi

Contributors

Elizabeth Binks

Senior Sister, The Duke of Cornwall Spinal Treatment Centre,

Salisbury District Hospital

John Carvell

Consultant Orthopaedic Surgeon, Salisbury District Hospital

Sue Cox Martin

Senior Occupational Therapist, The Duke of Cornwall Spinal

Treatment Centre, Salisbury District Hospital

Peter Guy

Consultant Urologist, Salisbury District Hospital

John Hobby

Consultant Plastic Surgeon, Salisbury District Hospital

Julia Ingram

Social Worker, The Duke of Cornwall Spinal Treatment Centre,

Salisbury District Hospital

Firas Jamil

Consultant in Spinal Injuries, The Duke of Cornwall Spinal

Treatment Centre, Salisbury District Hospital

Andrew Morris

Consultant Radiologist, Salisbury District Hospital

Nigel North

Consultant Clinical Psychologist, The Duke of Cornwall Spinal

Treatment Centre, Salisbury District Hospital

Wendy Pickard

Pressure Nurse Specialist, The Duke of Cornwall Spinal

Treatment Centre, Salisbury District Hospital

Anba Soopramanien

Consultant in Spinal Injuries, The Duke of Cornwall Spinal

Treatment Centre, Salisbury District Hospital

Rachel Stowell

Community Liaison Sister, The Duke of Cornwall Spinal

Treatment Centre, Salisbury District Hospital

Ian Swain

Professor of Medical Physics and Bioengineering, Salisbury

District Hospital

Anthony Tromans

Consultant in Spinal Injuries, The Duke of Cornwall Spinal

Treatment Centre, Salisbury District Hospital

Trudy Ward

Therapy Manager, The Duke of Cornwall Spinal Treatment

Centre, Salisbury District Hospital

Catriona Wood

Senior Clinical Nurse, The Duke of Cornwall Spinal Treatment

Centre, Salisbury District Hospital

The fourth edition of the ABC of Spinal Cord Injury, although now redesigned in the current ABC style, has the same goals as

previous editions. It assumes spinal cord injury to be the underlying condition, and it must be remembered that a slightly different

approach is used for trauma patients in whom spinal column injury cannot be excluded but cord damage is not suspected.

This ABC aims to present in as clear a way as possible the correct management of patients with acute spinal cord injury, step by

step, through all the phases of care and rehabilitation until eventual return to the community.

The book discusses how to move the injured patient from the scene of the accident, in conformity with pre-hospital techniques

used by ambulance services in developed countries, and it incorporates refinements in advanced trauma life support (ATLS)

which have developed over the past decade.

The text explains how to assess the patient, using updated information on the classification and neurological assessment of

spinal cord injury.

There is a greater emphasis in making the correct diagnosis of spinal injury and established cord injury—unfortunately,

litigation due to missed diagnosis is not uncommon. The pitfalls in diagnosis are identified, and by following the step by step

approach described, failure to diagnose these serious injuries should therefore be minimised.

Patients with an acute spinal cord injury often have associated injuries, and the principles involved in managing these injuries

are also discussed.

The later chapters follow the patient through the various stages of rehabilitation, and describe the specialised nursing,

physiotherapy and occupational therapy required. They also discuss the social and psychological support needed for many of these

patients in helping both patient and family adjust to what is often a lifetime of disability. Where applicable, the newer surgical

advances, including the use of implants which can result in enhanced independence and mobility, are described.

Later complications and their management are discussed, and for the first time there is a chapter on the special challenges of

managing spinal cord injuries in developing countries, where the incidence is higher and financial resources poorer than in the

developed world.

David Grundy

Andrew Swain

vii

Preface