Đang chuẩn bị liên kết để tải về tài liệu:
Critical Care Obstetrics part 25

Critical Care Obstetrics part 25 provides expert clinical guidance throughout on how you can maximize the chances of your patient and her baby surviving trauma. In this stimulating text, internationally recognized experts guide you through the most challenging situations you as an obstetrician are likely to face, enabling you to skillfully:Recognize conditions early-on which might prove life threatening, Implement immediate life-saving treatments in emergency situations, Maximize the survival prospects of both the mother and her fetus | Acute Spinal Cord Injury Table 18.1 Acute spinal cord injury basics of emergent care. Goals of therapy Stabilize the patient Immobilize the spine in an attempt to prevent further injuries Evaluate and treat other injuries Achieve early recognition prevention and management of frequently encountered complications. Management protocol Achieve initial patient stabilization including stabilization of the patient s neck airway management circulatory system assessment and fetal monitoring. Methylprednisolone should be considered within 8 hours of the SCI and given as a bolus dose of 30mg kg followed by infusion at 5.4 mg kg h for 23-48 hours. Hemodynamic monitoring may be required for optimum fluid management of neurogenic shock. Adequate fluid and pressor support may be necessary during the period of neurogenic shock. Delivery may be indicated for obstetric indications to facilitate maternal resuscitation or in conjunction with surgery for other injuries. Table 18.2 Acute spinal cord injury innervation of spinal segments and muscles and grading scale for evaluating motor function. Spinal segment Muscle Action C5 C6 Deltoid Arm abduction C5 C6 Biceps Elbow flexion C6 C7 Extensor carpi radialis Wrist extension C7 C8 Triceps Elbow extension C8 T1 Flexor digitorum profundus Hand grasp C8 T1 Hand intrinsics Finger abduction L1 L2 L3 Iliopsosas Hip flexion L2 L3 L4 Quadriceps Knee extension L4 L5 S1 S2 Hamstrings Knee flexion L4 L5 Tibialis anterior Ankle dorsiflexion L5 S1 Extensor hallucis longus Great-toe extension S1 S2 Gastrocnemius Ankle plantar flexion S2 S3 S4 Bladder anal sphincter Voluntary rectal tone Grade Muscle strength 5 Normal strength 4 Active power against both resistance and gravity 3 Active power against gravity but not resistance 2 Active movement only with gravity eliminated 1 Flicker or trace of contraction 0 No movement or contraction The predominant segments of innervation are shown in boldface type. Reproduced by permission from Chiles BW III Cooper