Navigating Spinal Cord Injuries in Critical Care

Nurse Eades

So, let’s start with the basics here—when we talk about spinal cord injuries, we divide them into two main types: primary and secondary. Primary injuries, those happen at the time of the trauma. Think of it like a direct blow—maybe a fall or a car accident that disrupts the spinal cord itself.

Jayla Thompson

So, like, the initial impact, right?

Nurse Eades

Exactly. Now, secondary injuries, they’re where things get trickier. These develop after that initial trauma and stem from things like ischemia, which is reduced blood flow, hypoxia, or swelling. They can cause further damage over hours or even days.

Jayla Thompson

Wait—so secondary injuries... they’re preventable?

Nurse Eades

To a degree, yes. That’s why timely interventions are so critical. If we can reduce swelling or restore blood flow early on, we have a chance at mitigating some of the longer-term effects. Actually, one case sticks with me—I was just a couple of years into my nursing career, and we had this teenager come in with a severe spinal injury from a diving accident. He was paralyzed at C6 initially, but rapid intervention—getting him to surgery, stabilizing his vitals—meant we saved more function than anyone expected. It was... well, it was a lesson I’ve carried with me.

Jayla Thompson

That’s—wow. That must've been intense. So, then, mechanisms of injury—does that tie into where the damage happens along the spine?

Nurse Eades

Exactly, Jayla. Different mechanisms affect the spine in specific ways. For example, flexion injuries, like from a sudden forward force in a head-on collision, can rupture ligaments and even dislocate vertebrae. Hyperextension injuries—these are caused by a force that pushes the neck backward—can compress the spinal cord. Then there’s compression from vertical force, like a fall landing on the feet.

Jayla Thompson

Oh, like a compression fracture?

Nurse Eades

Exactly that. And it all ties back to how we assess the injury. That’s where the ASIA Impairment Scale comes in. It’s a tool we use to classify the severity of spinal cord injuries—A through E—based on motor and sensory function.

Jayla Thompson

Okay, I think I remember this... 'A' means no motor or sensory function at all?

Nurse Eades

Right. That would be a complete injury, often catastrophic. At the other end, we have Grade E, which is essentially normal function after recovery. Most patients fall somewhere in between—like Grade B, where sensory function is intact but not motor, or Grade D, where at least half the muscles below the injury still work.

Jayla Thompson

And—I guess this depends on the level of injury, too, right? Like C4 injuries are way different than, say, lumbar injuries?

Nurse Eades

Absolutely. Injuries at higher levels, like the cervical area, impact much more. A C4 injury can mean complete paralysis below the neck, whereas a lumbar injury affects movement below the waist. And that’s why understanding the ASIA Scale and injury mechanisms helps us tailor patient care—from respiratory assistance to rehabilitation goals.

Jayla Thompson

Okay, so knowing this is... I guess, the foundation for everything else we’re gonna talk about.

Nurse Eades

That foundation you mentioned, Jayla—it’s exactly why we stress understanding complications early on. Take spinal cord injuries, for instance. Two of the scariest complications we see are spinal shock and neurogenic shock. At first glance, they might look similar, but in reality, they affect the body in very different ways.

Jayla Thompson

Right, uh, spinal shock... that’s when the reflexes below the injury stop working, right?

Nurse Eades

Exactly. It’s like the body temporarily shuts down those pathways, and it can last for days to weeks. During this time, the neurologic function is masked, so it’s tough to assess the true extent of the injury. Now, neurogenic shock, that’s a vascular issue—it happens when the injury disrupts sympathetic nervous system tone. Blood vessels lose that ability to constrict properly, and the patient’s blood pressure drops dangerously low.

Jayla Thompson

Wait, so—how do you even begin to manage that in, like, an acute situation?

Nurse Eades

Well, it’s critical to act fast. For neurogenic shock, we stabilize blood pressure—fluids first, vasopressors if needed. Monitoring is key, especially with injuries above T6 since that’s when the sympathetic nervous system is entirely disrupted. And imaging plays a huge role here too—CT scans, MRIs—you can’t diagnose secondary processes like hematomas, or even edema, without them.

Jayla Thompson

Mm, yeah... imaging is something I know is important, but... okay, so, there was this clinical I was in last semester. My patient’s BP started to drop, and instead of, you know, acting right away, I second-guessed myself. I checked everything twice, and by that time, my preceptor had already stepped in.

Nurse Eades

And what happened next?

Jayla Thompson

Well, honestly, she just told me that noticing it was half the battle, but I couldn’t hesitate like that. She—we—we adjusted their position, managed fluids, and things got stable, but I—I mean, it shook me. She said, “Always act on what you see—you can always reassess after.”

Nurse Eades

That’s—Jayla, that’s exactly the lesson here. Nursing isn’t always about getting it perfect; it’s about responding in the moment, especially with something like autonomic dysreflexia. Now, that’s another complication you’ll see more in the chronic phase. It’s life-threatening, caused by sensory stimulation below the injury level that the body just... reacts to uncontrollably. Blood pressure skyrockets—you’re looking for symptoms like a throbbing headache, sweating above the injury, flushing, or bradycardia. It’s a total SNS overreaction.

Jayla Thompson

So you treat it by, like, uh, finding the cause, right? Kind of working backwards?

Nurse Eades

Exactly. First, you elevate the head of the bed—get that BP down. Then find and resolve the stimulus. It could be as simple as an overfull bladder or even a wrinkle in the bedsheet causing pressure. Things like immediate catheterization, removing tight clothes, examining the skin for irritation... all of that can stop the chain reaction. But as you’ve learned, hesitation can cost time, and time matters.

Jayla Thompson

That makes sense... It’s just... there’s so much to think about at once.

Nurse Eades

That’s where practice and preparation come in, Jayla. Every patient, every shift builds those instincts. And here’s the thing—you noticed your patient’s hypotension. That means those instincts are already there.

Nurse Eades

And that’s exactly why preparation is so important. Every phase of care, from the scene of the injury to rehabilitation, relies on quick thinking and practice. Let’s start with the first step—prehospital care. It’s absolutely critical in setting the foundation for recovery.

Jayla Thompson

Like stabilizing the spine right away, right?

Nurse Eades

Exactly. Limiting movement of the spine is priority number one. Most patients are kept supine, with their head and spine aligned to prevent further injury. From there, the goal is all about maintaining airway, breathing, and circulation—the ABCs of trauma care. Every second matters when you’re trying to prevent secondary complications like swelling or hypoxia.

Jayla Thompson

And once they’re in the hospital, it’s about... surgical stabilization?

Nurse Eades

That’s a big part of it. Surgical stabilization can help decompress the spinal cord and eliminate damaging motion at the injury site. Sometimes we’ll see posterior or anterior approaches depending on the location of the injury. Surgery is also often complemented by drug therapy—for instance, vasopressors like norepinephrine are used to improve spinal perfusion in the acute phase. Every intervention, from pharmacologic to surgical, is designed to protect what function the patient has left.

Jayla Thompson

But how do you decide what’s the best approach for each patient?

Nurse Eades

That’s where the whole healthcare team comes in—neurologists, surgeons, nurses, therapists. It’s honestly amazing how multidisciplinary it really is. Recovery isn’t just about fixing the spine; it’s also about training the body and mind to adapt. Rehabilitation is key.

Jayla Thompson

I feel like rehabilitation must be, like... emotionally draining for patients too. I mean, learning to live with a new normal?

Nurse Eades

It is. Rehabilitation focuses not only on physiologic retraining but also on emotional and psychological support. Patients might spend hours in therapies each day—physical therapy, occupational therapy, even speech therapy depending on the injury level. Beyond the physical, though, there’s an emotional journey. That’s why psychological support is vital in addressing things like grief, anger, or even depression.

Jayla Thompson

Do you have... a story about that? About a patient going through rehab?

Nurse Eades

I do. There was this one young man—I’ll never forget him. He was in his early 20s, injured in a motorcycle accident, and became a paraplegic. When he first came to us, Jayla, he’d given up. He wouldn’t engage in therapy, wouldn’t talk to anyone. It was heartbreaking.

Jayla Thompson

Oh no... How do you even begin to help someone like that?

Nurse Eades

Patience, empathy, and showing up consistently. I worked closely with him, and one day out of the blue, he asked if there’d ever be a chance for him to kayak again. I said, “Not just a chance—if you’re willing, I’ll help you get there.” It was like a spark lit inside him. From that moment on, he was determined. Over months, he went from struggling to sit upright to mastering balance and arm strength. And, believe it or not, a year later, we went kayaking together. It wasn’t just about rehab—it was about showing him life wasn’t over.

Jayla Thompson

That’s... incredible. It’s like you helped him find hope again.

Nurse Eades

Sometimes that’s the most important thing we can do as nurses—be a source of hope. Whether it’s supporting physical recovery or just being present to help someone through the emotional weight, it’s all part of patient-centered care. It’s about seeing the person, not just the injury.

Jayla Thompson

That’s something I want to carry with me—to really focus on the whole person. I feel like this conversation has helped me connect the dots on everything—from immediate management to long-term care.

Nurse Eades

And that’s honestly the goal—to see the whole picture. Spinal cord injuries are complex, and recovery is a journey for every patient, but it’s also a testament to the resilience of the human spirit. And as nurses, we’re privileged to walk alongside them in that journey.

Jayla Thompson

That’s beautiful. Thank you for sharing all this. It’s really inspiring.

Nurse Eades

And thank you for being open. Every patient, every experience will shape you into the nurse you’re meant to be. And on that note, we’ve reached the end of today’s episode. It’s been great diving into this topic with you, Jayla—and to everyone listening, thank you for joining us on this journey through spinal cord injury care.