T.W. is a 22-year-old man who fell 50 feet from a chairlift while skiing and landed on hard-packed
snow. He is now at the emergency department (ED) with a suspected T5-T6 fracture with paraplegia.
Provider Orders:
I
...
T.W. is a 22-year-old man who fell 50 feet from a chairlift while skiing and landed on hard-packed
snow. He is now at the emergency department (ED) with a suspected T5-T6 fracture with paraplegia.
Provider Orders:
Insert Foley catheter
ECG monitoring
Immobilize the cervical spine
Oxygen at 4L/min via nasal cannula
Initiate two large-bore IVs
Neurologic assessment every hour
Apply warming blankets as needed
1. Describe a plan for implementing these orders.
The initial interventions in this situation would be to maintain the patient’s airway, give oxygen through
the nasal cannula, and immobilize the cervical spine to prevent its further damage. After the patient is
immobilized, I would perform a neuro assessment. The next steps would be to start IVs, place ECG
monitoring, insert foley catheter, and apply a warming blanket as needed.
2. What other interventions might be done by the ED nurse?
Other interventions would be:
Assess for ABCs to ensure that there are sufficient oxygenation and perfusion to organs
Assess for pain
Assess for paralytic ileus by listening to bowel sounds and palpating the abdomen for distension
Assess for symptoms of VTE due to high risk for VTE after spinal cord injury
Get labs such as CBC, lactate, and BMP
Get ready for CT scan
3. Awareness of the prehospital management of an SCI is critical to each patient's ultimate
neurologic outcome. What actions will the nurse take to ensure this goal is met?
Promote airway clearance and improve breathing
Immobilize the cervical spine with the head and neck maintained in a neutral position to prevent
further injury
Maintain urinary elimination
Decrease pain
Monitor for signs and symptoms of autonomic dysreflexia
Monitor for signs and symptoms of shock
Provide all needed information for triage at the hospital
4. The provider orders the following for T.W.: IV methylprednisolone (Solu-Medrol), bolus of 30
mg/kg over 15 minutes, followed by a maintenance infusion of 5.4 mg/kg body weight/hr.
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