I entail information around hasty medical attention to detail for someone who sustained a C1-C2 spinal cord injury 2 weeks ago.
In the early stages of care for C1-C2 quad, what should we expect:
1. What type of mattress should he be on? He's on a thin nouns mattress which doesn't adjust air pressure.
2. How often should he be turned or his position altered?
Seems like they don't revise his position much if at all!
3. He has a sip/puff mouth call button for the nurse. They do not respond efficiently enough. He is anxious and this is all so new for him - surely after lone a couple of weeks post injury and with such a high level of injury, they should be responding without hesitation?
4. They have not set up any systems for him in terms of communication. His household made a letter board, but the hospital have had no therapist or specialists come in to help with establishing methods of communication.
5. Shouldn't he be getting physical psychiatric therapy every day? He doesn't have any passive scale of motion exercises.
I would really appreciate any opinions, ideas, or resource information.
Thanks,
Bridgette
Answers: I'm sure he has "bought" himself a tracheostomy and is on a ventilator by presently. A feeding tube will be necessary, too, as C1-C2 quads are rarely competent to swallow until swelling subsides, if at all.
He certainly should have be seen by a speech pathologist by now. A letter board isn't critical, as his comprehension of speech is, more than likely, intact. Letter boards are for patients who can point to the letters to express themselves, not the other way around.
The speech pathologist can also assess for candidacy for a Passy-Muir spigot, which attaches to the trach and redirects the airstream through the vocal cords, thus enabling a merciful to speak.
Whoever is in charge of his care needs to speak next to the doctor (preferrably the neurosurgeon or neurologist, not the internist) and push for PT and ST evaluations/therapy right away. The PT will recommend the appropriate exercises for the prevention of limb contractures, and probably the use of braces, slings, etc. The ST will assess receptive/expressive language, cognition, swallowing, and speaking.
If the patient isn't within the ICU, it will generally take up to 10 minutes for the nursing staff to respond to a patient's call. He should be on a bed that moves him from side to side and stale his back constantly to avoid bedsores (decubiti), if the nurses aren't able to turn him every hour.
If he isn't getting the care he requirements or deserves, move him to a large teaching hospital where they accord with C1-C2 quads every day, preferrably to the neurosurgery or neurology unit. If I be in his position, I would insist on it.
C1-C2 fracture is a very delicate situation and his primary focus right presently will be establishing appropriate ventilatory protocol. Without knowing more about him such as how well his surgery went, etc one cannot read aloud whether or not it is appropriate to mobilize him. Certainly, prevention of bed sores, pneumonia and orthostatic hypotension are all important and can be addressed near position changes and therapy, but if that neck is not however stable enough for movement he will not be ready. This requires consulation from the surgeon.
Range of motion exercises can be taught by PT once he is cleared by the surgeon...you will most possible need to learn how to do them if you will be the primary caregiver.
If there is any system possible, once he is stable, the Rehabilitation Institute of Chicago remains the best rehab facility in the country and has an exceptional spinal cord care section. I would try to get him there once medically stable if you are in the nouns.
Here is a link to their spinal cord injury information center:
http://www.ric.org/conditions/spinalcord...
hi,I have been a home strength nurse for a couple of years now.I have only one client who is a C6 quad.Air mattresses are great but yes he should be turned every hour.Although he be only ingured 2 weeks ago they might not want to move him too much so they do not cause more ingury.
You have to get that in hospitals the nurses have so many patients that it is incredibly hard to run everytime someone hits a call button.He will have physical dream therapy soon but as i said before the doctors want to be sure that he will not be ingured more first.Normally most quads would be in the hospital for close to 6 months or more so plz have some mercy and i hope all is well with him.
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1. What type of mattress should he be on? He's on a thin nouns mattress which doesn't adjust air pressure.
2. How often should he be turned or his position altered?
Seems like they don't revise his position much if at all!
3. He has a sip/puff mouth call button for the nurse. They do not respond efficiently enough. He is anxious and this is all so new for him - surely after lone a couple of weeks post injury and with such a high level of injury, they should be responding without hesitation?
4. They have not set up any systems for him in terms of communication. His household made a letter board, but the hospital have had no therapist or specialists come in to help with establishing methods of communication.
5. Shouldn't he be getting physical psychiatric therapy every day? He doesn't have any passive scale of motion exercises.
I would really appreciate any opinions, ideas, or resource information.
Thanks,
Bridgette
Answers: I'm sure he has "bought" himself a tracheostomy and is on a ventilator by presently. A feeding tube will be necessary, too, as C1-C2 quads are rarely competent to swallow until swelling subsides, if at all.
He certainly should have be seen by a speech pathologist by now. A letter board isn't critical, as his comprehension of speech is, more than likely, intact. Letter boards are for patients who can point to the letters to express themselves, not the other way around.
The speech pathologist can also assess for candidacy for a Passy-Muir spigot, which attaches to the trach and redirects the airstream through the vocal cords, thus enabling a merciful to speak.
Whoever is in charge of his care needs to speak next to the doctor (preferrably the neurosurgeon or neurologist, not the internist) and push for PT and ST evaluations/therapy right away. The PT will recommend the appropriate exercises for the prevention of limb contractures, and probably the use of braces, slings, etc. The ST will assess receptive/expressive language, cognition, swallowing, and speaking.
If the patient isn't within the ICU, it will generally take up to 10 minutes for the nursing staff to respond to a patient's call. He should be on a bed that moves him from side to side and stale his back constantly to avoid bedsores (decubiti), if the nurses aren't able to turn him every hour.
If he isn't getting the care he requirements or deserves, move him to a large teaching hospital where they accord with C1-C2 quads every day, preferrably to the neurosurgery or neurology unit. If I be in his position, I would insist on it.
C1-C2 fracture is a very delicate situation and his primary focus right presently will be establishing appropriate ventilatory protocol. Without knowing more about him such as how well his surgery went, etc one cannot read aloud whether or not it is appropriate to mobilize him. Certainly, prevention of bed sores, pneumonia and orthostatic hypotension are all important and can be addressed near position changes and therapy, but if that neck is not however stable enough for movement he will not be ready. This requires consulation from the surgeon.
Range of motion exercises can be taught by PT once he is cleared by the surgeon...you will most possible need to learn how to do them if you will be the primary caregiver.
If there is any system possible, once he is stable, the Rehabilitation Institute of Chicago remains the best rehab facility in the country and has an exceptional spinal cord care section. I would try to get him there once medically stable if you are in the nouns.
Here is a link to their spinal cord injury information center:
http://www.ric.org/conditions/spinalcord...
hi,I have been a home strength nurse for a couple of years now.I have only one client who is a C6 quad.Air mattresses are great but yes he should be turned every hour.Although he be only ingured 2 weeks ago they might not want to move him too much so they do not cause more ingury.
You have to get that in hospitals the nurses have so many patients that it is incredibly hard to run everytime someone hits a call button.He will have physical dream therapy soon but as i said before the doctors want to be sure that he will not be ingured more first.Normally most quads would be in the hospital for close to 6 months or more so plz have some mercy and i hope all is well with him.
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