ABCD: Airway and Breathing – Nursing Care for Acute Spinal Cord Injury

00:00 Now, what are the initial priorities? That's always what you wanna be thinking about.

00:04 What's our top priority? Well, before they come to the hospital and in the emergency room, the priorities are to maintain the airway and prevent secondary or further injury to the spinal cord.

00:14 Remember, no matter where the patient is, it's always ABC. Right? And in spinal cord injury, we're really worried about preventing further damage or injury to the spinal cord.

00:26 So you're gonna look for other injuries that the patient might have, but we're really gonna give priority to not allowing anything else to happen to that spinal cord.

00:34 So we're gonna add a letter for you.

00:37 You know, I said any unit, its airway, breathing, circulation, right? Your ABCs. We're also gonna talk about the D.

00:45 So we've got airway, breathing, circulation, our regular ABCs.

00:50 And in this case, we're gonna be thinking about disability or the neurological status.

00:55 So, how do we make sure that we minimize any further complications or damage to that spinal cord? Okay. So we're gonna start in the regular place; airway and breathing.

01:06 Okay. So high cervical spinal cord injury, now remember what that means, if cervical, thoracic, lumbar.

01:14 So we're talking about the vertebra there at the top of the spinal cord.

01:18 So a high cervical spinal cord injury is likely to have impairment with breathing and will need airway support.

01:26 So we know the higher the injury, the more significant the damage afterwards.

01:31 And high cervical injuries have impaired breathing and will require some type of airway support more than likely.

01:37 So, many of the cervical spinal cord injuries require intubation in the first 24 hours.

01:43 Remember, intubation is when its procedure done by a physician or in the field by paramedics where they insert a tube down into the trachea that you can attach a ventilator to.

01:54 Or we can even Ambu bag somebody with it, but usually attach a ventilator to it to help them breathe because a person with a spinal cord injury is at extra risk with hypoxia.

02:05 We know they already might have a problem breathing and we wanna keep them very well oxygenated.

02:11 Now, don't we wanna keep everyone oxygenated? Yes.

02:15 But we wanted to point out to you that hypoxia and a spinal cord injury can really affect their long-term neurological outcome.

02:22 So airway is important for everyone and that's a specific point on why it's important to a spinal cord injury.

02:29 So, you're looking at the arterial oxygenation, you wanna make sure that you monitor it and you keep giving oxygen supplementally as needed.

02:36 So when we say monitoring arterial oxygenation, that's gonna require an ABG; an arterial blood gas will be drawn from an artery. Okay.

02:47 So we're starting into the first one; A.

02:49 So thinking about airway and breathing.

02:51 So as a nurse, what are some specific interventions? What are the things that you would do? Well, your key here is assessment.

02:59 I want you to watch the respiratory rate, listen to the lung sounds, watch the pulse ox, draw the ABGs and interpret them, chest x-ray and PFTs; pulmonary function tests.

03:12 Because like with any patient, if the patient is beginning to get in trouble, we wanna catch it early so you can intervene.

03:19 Now, you might have to suction the patient if they don't have the ability to cough very well if they have secretions.

03:25 Remember, in order to cough fairly well, I have to have abdominal muscles, intercostal muscles and a diaphragm.

03:31 If those three are not working well together, the patient might not be able to get rid of those secretions.

03:36 And if they're intubated, it's gonna be easier process to suction them.

03:40 Keep watching the supplemental oxygen, or if they're intubated, you always wanna watch that pulse ox to see, "Do we need to titrate up on the oxygen or can we come down a little bit?" When you're working with a healthcare provider's orders.