Case 1: Mr. DJ

We would like to graciously acknowledge Colleen O’Connell, MD FRCPC for her contribution to the development of this case study.

David is a 26 year-old man who was vacationing at a friend’s cabin on the July long weekend. He dove off a pier into water with large rocks and sustained a hangman’s fracture with C2-C3 bilateral interfacet dislocation and multilevel posterior column fractures (C3-C5). After being pulled from the water he was unconscious and not breathing. Paramedics resuscitated him and he was transferred to a tertiary care trauma center where he underwent multilevel fusion of the cervical spine. 

David entered rehabilitation with an injury severity of C3 AIS B. After two months of rehabilitation David developed redness on his coccyx despite good skin care by nursing staff and frequent repositioning. His rehabilitation team is concerned about the possibility of developing a pressure ulcer.

What is the incidence and prevalence of pressure ulcers in persons with SCI?
Annual incidence rates range from 20-31% and prevalence rates range from 10-30%.
 Name prevention strategies that the rehabilitation team could implement that would prevent further tissue damage and promote skin integrity.

· Adjustments in up time; nutritional assessment and correction of nutritional deficiencies;
assessment and treatment of potential factors contributing to non-healing
(e.g. thyroid disease, hypotestosterone, smoking cessation etc.)
· Pressure ulcer education
· Seating assessment
· Cushion selection
· Pressure mapping
· Pressure relief practices
· Electrical stimulation