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Paraplegic Rehabilitation in South Africa

Acute Management I

Medical Treatment

Zamani was admitted to the intensive care unit on 2 Nov 1995. The doctor explained the pathology and effects of the injury to Zamani and his family. He also discussed immediate management and rehabilitation.

Initial management was geared towards stabilising physiological function, providing psychological support, and preventing pressure sores and contractures or stiffness.

Zamani experienced severe pain localised at the injury site. A propoxyphene combination analgesic was prescribed. Two tables 4 times a day were administered orally.

No signs of spinal shock were present. Signs of spinal shock are more profound in patients who sustain high spinal cord lesions.

Nursing

The nursing staff took vital signs regularly.

Bladder Control

An indwelling catheter was still in situ. Fluid intake and output were regularly measured.

Bowel Control

Zamani started eating because he had a normal bowel. Every second day, Senokots® (laxative) was administered in the morning and Dulcolax® (suppository) in the afternoon to initiate bowel movements.

Pressure Care

To prevent the development of pressure sores, Zamani was lifted every three hours by the turning team to relieve pressure. His buttocks, sacrum, back, and heels were checked for red marks at each turning session.

Zamani could not lie on his sides yet, because his spinal fracture was still unstable. Therefore he was lying on a packbed with pillows to reduce pressure on areas such as the sacrum and heels that most commonly develop sores.

Good positioning is important to ensure the spine is in a good healing position.