HISTORY. Determine the mechanism of injury in addition to taking a detailed report from prehospital professionals about the patient with an acute SCI. Question the prehospital care provider, significant others, or witnesses about the situation surrounding the injury. If the patient was in an MVC, determine the speed and type of the vehicle, whether the patient was restrained, the patient's position in the vehicle, and if the patient was thrown from the vehicle on impact. If the patient fell, the distance of the fall is important to know during the initial assessment and evaluation phase. A key component of the history in the patient with a suspected acute SCI is information about the patient's motor and sensory function at the scene of the injury.

PHYSICAL EXAMINATION. Assess the patient as soon as possible after the primary injury and again each hour during the acute period. Neurological assessments usually include the Glasgow Coma Scale and pupil reflexes.

The initial assessment is conducted at the injury site. This primary survey generally takes about 30 seconds and focuses on assessing airway, breathing, and circulation and implementing life-saving intervention. Stabilizing the cervical spine prevents an incomplete SCI from progressing to a complete one. The secondary survey is a complete head-to-toe assessment. Sometime during the first 48 hours, a tertiary survey is performed to discover any subtle injuries that may have been missed during the initial assessment.

Assess the patient's injury level. Test the patient's ability to distinguish a pinprick from dull pain at each level of the dermatomes. Rectal examination helps determine if the sphincter tone is normal and if the SCI is complete or incomplete. Normal sphincter tone and anal winking indicate an incomplete SCI. Evaluate the patient's motor strength to help determine the injury level. Test the patient's motor movement.

Examine the patient for signs of neurogenic shock, which usually occurs within 30 to 60 minutes after the SCI when sympathetic nerves have lost their normal connections to the central nervous system (CNS). Signs to look for include decreased heart rate and pronounced hypotension (systolic pressure below 90 mm Hg).

PSYCHOSOCIAL. Acute SCI is catastrophic and alters not only the lives of patients but also the lives of their families, friends, and the community they live in. Physiological alterations are significant in patients with acute SCIs, as are the psychosocial adjustments. Ongoing assessment of the patient's and family's coping skills is critical in planning meaningful support and interventions to assist the patient in reaching her or his functional potential.

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