Individuals with chronic spinal cord injury (SCI) present a host of challenges to the clinicians who care for them. The typical signs and symptoms of many disorders are often lacking, requiring us to maintain a high level of suspicion for those that threaten further disability or even death. The profound physiologic changes associated with SCI also require us to reevaluate traditional therapeutic modalities in this setting...This third edition of Emergencies in Chronic Spinal Cord Injury Patients addresses many of these wide-ranging issues. This updated guide provides a practical approach to the types of emergencies likely to be encountered in the population with SCI. Each chapter, authored by experts in the field, addresses a specific aspect of emergency management. This text is essential for clinicians who have limited experience with patients with SCI. Specialists in spinal cord medicine will find a useful review of the state-of-the-art of emergency management. From the Foreword by Joel A. DeLisa, MD, MS SCI has tremendous repercussion on bodily functions below the level of injury. This text was developed primarily for the purpose of providing guidelines for managing emergencies in patients with chronic SCI based on the differences in pathophysiology that follow SCI, and to avoid unintentional mismanagement strategies such as: [yen] A patient with autonomic dysreflexia may be diagnosed as essential hypertension not realizing that the hypertension is a result of a plugged catheter or impacted rectum; as a result of inappropriate treatment the patient may develop a cerebrovascular accident. [yen] A patient with bowel perforation may be misdiagnosed as having fecal impaction (constipation) and may be operated on late with high mortality and morbidity. [yen] A patient with septic arthritis of the hip secondary to a pressure sore was scheduled for hip disarticulation when he could have been treated with an upper femorectomy and plastic reconstruction, thus saving the limb. [yen] Patients having occlusive arterial disease of lower extremity have been scheduled for amputation, when the limbs could be salvaged by an angioplasty and medical treatment with adjunctive hyperbaric 02 therapy.




