Physiological Adaptation Q 182
A patient with a spinal cord injury at level C3-4 is being cared for in the ED. What is the priority assessment?
A. Determine the level at which the patient has intact sensation.
B. Assess the level at which the patient has retained mobility.
C. Check blood pressure and pulse for signs of spinal shock.
D. Monitor respiratory effort and oxygen saturation level.
Correct Answer: D. Monitor respiratory effort and oxygen saturation level.
The first priority for the patient with an SCI is assessing respiratory patterns and ensuring an adequate airway. The patient with a high cervical injury is at risk for respiratory compromise because the spinal nerves (C3 – 5) innervate the phrenic nerve, which controls the diaphragm.
Option A: Determining this data can be done after addressing the concerns on the respiratory status of the patient.
Option B: This data can be assessed after monitoring the respiratory effort and oxygen saturation level of the patient.
Option C: Vital signs checking is also necessary, but not as high priority. Vital signs can be quite abnormal following SCI. In addition to the usual causes in trauma such as pain, bleeding, and distress, this can be due to loss of autonomic control, which occurs particularly in cervical or high thoracic injuries. The autonomic nervous system controls our HR, BP temperature, etc. Autonomic instability is most acute in the first few days to weeks of the injury.