Acute spinal cord injury

The primary goal of emergent care of a pregnant patient with an acute spinal cord injury (SCI) is to diagnose and treat life-threatening injuries, while preventing any unnecessary traction or motion of the spinal column. The pregnant SCI patient also has increased engorgement of respiratory mucosa to increase her pulmonary secretions. Patients may be prone to more respiratory complications from aggressive fluid resuscitation if neurogenic shock is unrecognized and treated as hypovolemic shock. Of primary importance in managing the patient with cervical or high thoracic SCI is the prevention, prompt recognition, and treatment of autonomic dysreflexia (AD). Immediate management of AD is orientated toward identifying and removing the inciting stimulus while managing the potentially dangerous rise in blood pressure (BP). There is a significant risk of venous thromboembolism (VTE) after SCI, with reported incidence during acute SCI ranging widely depending on the method of surveillance.