Patient handout

Acute Traumatic Spinal Cord Injury (SCI)

PRODUCTION

1. Your condition

This handout is for acute traumatic spinal cord injury (sci). Your care team identified this based on: blunt trauma (mvc / fall / sports) with focal motor or sensory deficit (aans/cns 2013 pmid 23839357).

Other reasons your team may use this plan: penetrating neck / back injury (gsw / stab) with focal deficit (aans/cns 2013 pmid 23839357); high cervical (c3-c5 phrenic involvement) injury with diaphragm paralysis / respiratory failure → stat intubation (aans/cns 2013 pmid 23839357); neurogenic shock — hypotension + relative bradycardia + warm peripheries above t6 (karsy/hawryluk curr neurol neurosci rep 2019 pmid 31363857).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
norepinephrine	0.05-0.1 mcg/kg/min IV titrate to MAP ≥85 mmHg (typical adult start 5-10 mcg/min)	IV	continuous infusion	Norepinephrine preferred first-line vasopressor in acute SCI for combined alpha + mild beta support (treats both vasoplegia and relative bradycardia of high cord injuries) per Karsy/Hawryluk Curr Neurol Neurosci Rep 2019 (PMID 31363857); Hawryluk MAP-recovery doctrine (PMID 25669633)
phenylephrine	0.5-1 mcg/kg/min IV (typical adult start 40-100 mcg/min); push-dose 50-200 mcg IV for transient hypotension	IV	continuous infusion	Pure alpha-agonist alternative when tachyarrhythmia limits norepinephrine; can worsen bradycardia of high cervical injury — monitor for reflex bradycardia (AANS/CNS 2013 PMID 23839357)

Plan: Acute SCI secondary-injury-prevention bundle: MAP ≥85 × 7 d + early decompression + DVT prophylaxis + spasticity + autonomic-dysreflexia (AANS/CNS 2013 PMID 23839357 + Fehlings AOSpine 2017 PMIDs 29164026/29164028/29164029 + Fehlings AOSpine 2024 update PMID 38526922 + Hawryluk PMID 25669633)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Doing well — stable recovery

If you have:

stable_function
intact_skin
effective_bladder_bowel_regimen
no_autonomic_dysreflexia_episodes

Do this:

Continue rehab program + bladder/bowel/skin routines
Take spasticity + anticoag + other medications as prescribed
Reposition every 2 hours when in bed; pressure relief every 15-30 min in chair
Keep all SCI-clinic, urology, and PCP appointments

YELLOW — Caution — call SCI clinic same day

If you have:

new_pressure_redness_>1h
new_UTI_symptoms
worsening_spasticity
mild_autonomic_dysreflexia_headache_BP_rise
mood_concerns
fall_without_new_deficit

Do this:

Call SCI clinic / PCP same day
For autonomic dysreflexia: sit up, loosen restrictive clothing, check + drain bladder, check + clear bowel
For pressure redness: offload immediately + skin protection
For UTI symptoms: bring urine sample to clinic

RED — Emergency — call 911 / go to ED

If you have:

new_weakness_or_sensory_loss
severe_autonomic_dysreflexia_SBP_>200_or_persistent
major_bleeding
severe_chest_pain_or_dyspnea
high_fever_with_altered_mental_status
unable_to_void_+_bladder_distension

Do this:

Call 911 / go to nearest ED
Bring SCI summary card + medication list + autonomic-dysreflexia card
Tell ED you have an SCI at [level] — they MUST treat AD with sit-up + trigger removal + SL nitroglycerin if SBP>150

Call your provider if:

Any red-zone trigger
After any ED visit

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

High cervical SCI (C3-C5 phrenic involvement) with diaphragmatic paralysis / respiratory fatigue / rising PaCO2 / FVC <15 mL/kg (AANS/CNS 2013 PMID 23839357)(life-threatening)
Hypotension in trauma patient with relative bradycardia + warm peripheries (above T6 SCI) — RULE OUT HEMORRHAGE FIRST (FAST, CT chest/abdomen/pelvis) (AANS/CNS 2013 PMID 23839357)(life-threatening)
ASIA Impairment Scale A — no motor or sensory function preserved in sacral segments S4-S5 (AANS/CNS 2013 PMID 23839357)(life-threatening)
T6 or above SCI with SBP >20 mmHg above baseline + headache ± bradycardia ± flushing above lesion + pallor / sweating below (Karsy/Hawryluk PMID 31363857)(life-threatening)
Gunshot / stab / shrapnel SCI (AANS/CNS 2013 PMID 23839357)
Elderly patient with cervical spondylosis + minor hyperextension injury → central cord syndrome (upper>lower extremity weakness, bladder dysfunction, often AIS D) (Badhiwala/Fehlings PMID 30611186)
Pediatric (<13 yr) SCI Without Radiographic Abnormality on CT — cord injury visible only on MRI (AANS/CNS 2013 PMID 23839357)
GCS ≤8 OR major intracranial lesion concurrent with SCI (AANS/CNS 2013 PMID 23839357)(life-threatening)
MAP <85 mmHg persistent despite norepinephrine + phenylephrine (Hawryluk PMID 25669633)

5. Follow-up

SCI rehab centre referral; long-term complications: autonomic dysreflexia (T6+), neurogenic bladder, neurogenic bowel, pressure injury, spasticity, heterotopic ossification, mood/cognition, sexuality/fertility, vocational; lifelong management (Fehlings AOSpine 2017 rehab PMID 29164029)

6. Sources

Guideline: AANS/CNS 2013 Guidelines for the Management of Acute Cervical Spine and Spinal Cord Injuries (Walters/Hadley, Neurosurgery 2013) + AOSpine/AANS-CNS 2017 Joint Guidelines (Fehlings, Global Spine J) + AOSpine 2024 Update on Timing of Decompressive Surgery (Fehlings, Global Spine J 2024)