What to ask your doctor?

For Friends and Family of the Newly Injured

What to ask your doctor

Families and friends often don’t even know what questions to ask the doctors. Here are some questions to ask in the first hours after injury:

  • Was methylprednisolone given? This is the high-dose steroid (30 mg/kg intravenous bolus followed by 5.4 mg/kg/hour for 23 hours if it is started within 3 hours and for 47 hours if between 3 to 8 hours after injury). It should not be started more than 8 hours after injury. Clinical trials have shown that this treatment improves recovery by about 20% when given within 8 hours after injury but does not help when started more than 8 hours after injury. While methylprednisolone is not a cure, every little bit helps. Complications are minimal.
  • What is the level and severity of spinal cord injury? The consequences of spinal cord injury depend on the level and severity of injury. Surgeons determine injury levels from the fracture site on the spinal column. This may differ from neurological level determined from sensory and motor loss. Spinal cord injury causes loss of sensation and voluntary movement below the injury site. If the person has motor or sensory function below the injury level at the time of admission, the likelihood of substantial recovery is high.
  • Has the spinal cord been decompressed? The spinal cord injury usually results from fracture of vertebral bones that compress the spinal cord. Continued spinal cord compression increases tissue damage and reduces functional recovery. If the neck or cervical segments are fractured, traction may straighten out and decompress the vertebral column. Chest or thoracic fractures cannot be decompressed by traction. Surgery may be necessary to decompress and stabilize the spinal cord.
  • Has anticoagulation been started? Blood clots may form in the legs and migrate to the lungs. This is a serious complication that can be prevented by giving anticoagulants such as heparin or coumadin. It may be necessary to place a filter (Greenfield filter) in the vein to the heart to catch clots.
  • Pulmonary, bladder, and skin care? Spinal cord injury may compromise breathing and coughing. After cervical spinal cord injury, artificial respiration may be necessary and pneumonia is common. Spinal cord injury paralyzes the bladder and a catheter must be placed in the bladder to drain urine. Continued pressure on the skin causes skin sores called decubiti. Cushioning vulnerable areas and regular turning prevents this.