A patient is admitted to the ICU with a C5–C6 subluxation fracture. He is able to move his legs better than he can move his arms. Caring for the patient would include which of the following interventions?
a. Keeping the room cool, dark, and quiet
b. Administering intravenous methylprednisolone for the first 24 hours after the injury
c. Elevating the head of the bed 45 degrees
d. Resuscitating low blood pressure by only using intravenous fluid
B
Intravenous methylprednisolone controls spinal cord ischemia and swelling, thereby minimizing the extent of tissue damage. The room should be kept warm to avoid hypothermia. Elevating the head of the bed will often cause hypotension and is contraindicated until additional spinal cord injuries have been ruled out. Because of the profound vasodilation found with neurogenic shock, patients should be resuscitated with both intravenous fluids and vasopressors to restore intravascular volume as well as vascular tone.
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