How should I manage a patient with paralysis following a traumatic injury in terms of immediate care and follow-up?

Immediate Care:

• At the scene, follow the ABCDE trauma assessment sequence prioritising catastrophic haemorrhage, airway with in-line spinal immobilisation, breathing, circulation, disability (neurological), and exposure/environment.
• Protect the cervical spine with manual in-line spinal immobilisation during airway management and avoid moving the rest of the spine to prevent further injury.
• Assess for spinal injury signs such as spinal pain, motor weakness, sensory changes, priapism, and altered consciousness; if any are present or assessment is not possible, maintain full in-line spinal immobilisation.
• Do not use methylprednisolone, nimodipine, or naloxone in the acute stage for neuroprotection or prevention of secondary deterioration.
• Contact the linked spinal cord injury centre consultant within 4 hours of diagnosis to establish a partnership of care.

Follow-up and Rehabilitation:

• Ensure the patient receives a lifetime of personalised care guided by a spinal cord injury centre.
• Start rehabilitation as soon as the patient is medically stable and able to participate, ideally no later than the day after surgery if applicable.
• Implement a 24-hour positioning and turning programme with pressure-relieving mattresses to prevent pressure sores, ensuring spinal stability before use.
• Monitor for complications such as autonomic dysreflexia (a medical emergency) and orthostatic hypotension, managing these proactively.
• Maintain joint range of motion using splints and orthoses early, with specialist advice for high cervical injuries to preserve hand function.
• Assess and support respiratory function, swallowing, and speech as needed, referring to specialists accordingly.
• Provide psychological and emotional support promptly, involving mental health teams if pre-existing or new psychological issues are present.
• Communicate clearly and honestly with the patient and their family or carers, managing expectations without speculation and providing a clear point of contact for information.