E - EARLY ACUTE CARE
E.1.1
Clinicians should monitor individuals with acute cervical SCI in the intensive care unit or a comparable high acuity unit with continuous monitoring. (CAN-SCIP 2020; Level C)
E.1.2
Patients with SCI requiring mechanical ventilation should be considered for early tracheostomy. (CAN-SCIP 2020; Level B)
E.1.3
Intensive care unit management of patients with acute traumatic central cord syndrome, particularly patients with severe neurological deficits, is recommended. (CNS-ATCCS 2013, p.195; Level C)
E.1.4
To improve spinal cord perfusion, medical management, including cardiac, hemodynamic, and respiratory monitoring, and maintenance of mean arterial blood pressure at 85 to 90 mm Hg for the first week after the injury is recommended. (Adapted from CNS-ATCCS 2013, p.195; Level C)
E.1.5
We recommend mechanical insufflation-exsufflation as adjunctive therapy to assess bronchial clearance in acute SCI patients. (CAN-SCIP 2020; Level B)
E.1.6
We recommend clinicians prescribe midodrine hydrochloride as a treatment option to improve orthostatic hypotension. (CAN-SCIP 2020; Level B)
E.2.1
In the acute phase, rehabilitation setting, and community setting, individuals with SCI should have access to a registered dietitian familiar with the metabolic changes associated with SCI. (Adapted from NUTR 2009, p.2; Level B)
E.3.1
In the acute phase after injury, the registered dietitian should assess energy needs by measuring energy expenditure. Individuals with SCI have reduced metabolic activity due to denervated muscle. Actual energy needs are at least 10% below predicted needs. Indirect calorimetry is more accurate than the estimation of energy needs in critically ill patients. (Adapted from NUTR 2009, p.14; Level A)
E.4.1
We suggest clinicians replace an extrication cervical collar with an acute care rigid collar as soon as feasible in consultation with a qualified trauma team member. (Adapted from NPUAP 2014, p.9; Level C)