Quick reference algorithm

Spinal Cord Injury Algorithm

Acute spinal cord injury patients · March 2026 edition

MAP goal 85–90 mmHg × 5–7 daysDecompression target: within 24h of injury

Phase 1: 0–20 Minutes

SCI Patient — ED Arrival

Backboard removal
Spinal precautions
ATLS primary survey

Hypotensive?

YESShock type ↓NOSkip to ICU admission (Phase 2) ↓

Hemorrhagic Shock

Tachycardic + Cool extremities

ATLS, FAST, blood products

Neurogenic Shock

Bradycardic + Warm extremities

Norepinephrine preferred

Target MAP 85–90 mmHg

Mixed / Unclear

Treat hemorrhagic FIRST

Volume resuscitate → then vasopressors

Phase 2: 0–2 Hours

ICU Admission

ASIA exam
Arterial line
Foley catheter

MAP goal 85–90 mmHg × 5–7 days

Temperature monitoring (SCI patients are poikilothermic)

Phase 3: 2–6 Hours

MRI if indicated • Spine surgery consult

Assess for cord compression, ligamentous injury

MPSS Decision

Within 8h of injury

(Controversial — shared decision with patient)

MPSS: methylprednisolone sodium succinate

Elected

MPSS Elected

30 mg/kg IV bolus

then 5.4 mg/kg/hr × 23h

Monitor for hyperglycemia, infection

Declined

MPSS Declined

Document decision + rationale
Continue standard care

Phase 4: 0–24 Hours

Surgical decompression indicated?

YES → Decompression

Target: within 24h of injury

Early decompression associated with improved outcomes

NO → Continue Monitoring

Serial ASIA exams
MAP support ongoing

Phase 5: 24–48 Hours

VTE Prophylaxis

Start chemical prophylaxis at 24–48h

Per weight-based enoxaparin table (see VTE Decision Tree)

Phase 6: 3–7 Days

Ongoing ICU Management

Continue MAP support 85–90 mmHg
Wean vasopressors as tolerated
Bowel/bladder protocol
Temperature regulation

Respiratory Monitoring

FVC and NIF q4–6h if cervical SCI

Intubate if:

FVC < 15 mL/kg OR NIF weaker than −20 cmH₂O