Management of spinal cord injury.

Family physicians can help prevent spinal cord injuries by patient education about alcohol, drugs, seat belts, and football safety rules. Immobilization at the site of injury is essential to prevent incomplete cord injuries from becoming complete. Treatment is urgent; hemorrhagic necrosis of the cord is reversible only up to four hours after injury. Physicians must inform patients and families that regional spinal injuries centers provide the best care, with lowest total costs, and shortest hospital stay. Initial treatment includes immobilization, with or without surgery, prophylactic anticoagulants, and sometimes steroids and local hypothermia. Intermittent catheterization has revolutionized bladder control and reduced the incidence of infections. The most common causes of death are renal failure and pulmonary complications, sitting stability, strengthening non-paralyzed muscles, and providing equipment for maximum function. Psychologists, who work with families as well as patients in developing coping strategies, are important members of rehabilitation teams. Seventy percent of paraplegics return to the community within six months of injury, and nearly 50 percent achieve satisfactory sexual activity.