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essay of explanation Can result in loss of bowel and bladder viagra buy cheap online control. Recovery of function is low, although ambulation is more common than bladder and bowel recovery. Cauda equina comprises about 10% of all spinal cord injuries. Sensory motor recovery chances are moderate. Ambulation loss and motor dysfunction. Can also involve bladrecovery more likely than bladder. Urgent decompression within 72 hours maximizes der and bowel dysfunction if lower sacral root favorable outcomes. Involvement. With high-dose methylprednisolone, particularly in attenuating in ammation and its accompanying cascade o e ects in the local areas o injury. However, these studies were insu ciently powered and also illustrated the numerous potential side e ects o early steroid use, including heightened rates o pneumonia, sepsis, in ection, and respiratory issues.44 additionally, those who have sustained concomitant injuries, as well as those with speci c comorbidities that raise the risk or in ection (eg, diabetes mellitus, dyslipidemia, high blood pressure, hiv) are at an increased risk or complications. Surgical intervention to provide decompression o the cervical spine has been shown to have the potential to bene t neurological recovery in both the short as well as the long term through the prevention o secondary injury mechanisms. Determining the optimal timing or such intervention is important. A recent prospective study (s ascis) ound that decompression spinal surgery within 24 hours o injury is associated with improved neurological outcome, as assessed by at least a two-score improvement in ais classi cation at 6 months a er injury.45 however, only approximately a quarter to a hal o all patients with sci are eligible to undergo such surgery within the rst 24 hours o injury, as a result o transportation delays and the need to address other li e-threatening injuries rst. Decompression surgery outside o 24 hours was still ound to be bene cial, with 8.8% o patients able to improve 2 grades on the ais scale and none in this late-intervention group regressing in grade. In summary, surgical decompression o the spinal column is recommended as soon as possible ollowing injury. Both the clinical evidence and literature suggest that such an approach will give patients the best chance at improved neurological recovery. An important consideration is that in the a orementioned study, those with a gcs score less than 13 were excluded to avoid bi inter erence in ais assessment, thereby a ecting true determination o neurological impairment as it relates to the spinal cord. Patients should be transitioned to an icu or appropriate acility ollowing attenuation o immediate li esaving concerns and initial treatment o the sci. Care should be taken to avoid any urther perturbation o the injury to mitigate the risk o secondary neurological damage. Early rehabilitation includes interdisciplinary care to prevent secondary complications, including skin pressure ulceration, joint contractures, venous thrombosis, respiratory in ection, bowel impaction, bladder distension, malnutrition, and deconditioning. Aggressive treatment should address patient education, behavioral health support, e ective pain management, and early therapy to promote enhanced communication, activities o daily living, and mobility. What particular risks and complications x does traumatic sci present?. Cardiovascular complications are o great concern in those with sci, due to the risk or ischemia. Cardiac and hemodynamic parameters should be monitored or up to a week ollowing sci. Mean arterial blood pressure should not be allowed to decline below 85 mmhg, 246 ch apt er 15 and systolic blood pressure should be maintained > 90 mmhg. Steps should be taken to prevent the development o dv in the acute phase, as this can a ect individuals with sci when no prophylaxis is taken. T is can be addressed with the same considerations and prophylaxis as described or bi, although pharmacological intervention should be withheld appropriately 24–48 hours a er spinal surgery to avoid any complications. Reatment should continue or 6 weeks ollowing sci up to 3 months, depending on the severity and level o injuries. Due to the lengthy hospital stays and immobilization that many patients require, many are at risk or decubitus ulcers and skin breakdown. Patients should be removed rom the backboard as soon as possible to avoid this risk.

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http://projects.csail.mit.edu/courseware/?term=community-service-essay-ideas community service essay ideas I necessary and available, a rotating bed can be bene cial or patients who cannot be mobilized. Patients should be examined or indications o ulcer development or skin breakdown regularly, as decubitus ulcers may not become evident or a number o days.

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