Actionable Nuggets (3rd ed., 2016)

1. Epidemiology of Spinal Cord Injury
Be aware of the most important health risks for patients with spinal cord injuries

2. Screening for Cardiovascular Risk in SCI
Screen for cardiovascular risk factors at least annually

4. Autonomic Dysreflexia
Alert patients with SCI at T6 and above to the risks of Autonomic Dysreflexia, and the need for urgent attention at the onset of an episode

5. Assessment of Pain in SCI Patients
Distinguish between neuropathic and musculoskeletal pain in your patient with SCI, and monitor pain regularly

6. Pharmacological Management of Neuropathic Pain
Use a step-wise evidence-based protocol for the management of neuropathic pain in SCI, and review pain management annually

7. Management of Musculoskeletal Pain
Chronic musculoskeletal pain requires an interdisciplinary approach, including rehabilitation, and in some cases, surgery

8. Annual Assessment of Neurogenic Bowel
Conduct an annual assessment of bowel function in patients with SCI

9. Periodic Re-evaluation of Bowel Management Program
A step-wise approach to bowel management is recommended, with involvement of SCI specialists as needed

10. Diet and Fluid Management in Neurogenic Bowel
Refer spinal cord injured patients with persistent constipation to a specialist with experience with spinal cord injury or neurogenic bowel

11. Screening for Colorectal Cancer in SCI Patients
Initiate colorectal cancer screening for patients with SCI using the same principles as those for the general population

12. Monitoring of Neurogenic Bladder
Bladder management should be reviewed annually by the family physician, and periodically by a urologist

13. Recognizing Urinary Tract Infections in SCI Patients
Diagnosis of UTI in SCI requires three criteria: (1) significant bacteriuria; (2) pyuria; AND (3) signs and symptoms

14. Pharmacological Management of UTI in SCI
There is no superior agent or class of antibiotics for UTIs in spinal cord injury. Recurrent UTIs should be treated as complicated infections, and treatment must be customized to the patient and the infecting organism

15. Screening for Bladder Cancer in SCI Patients
Routine screening for bladder cancer is recommended only for high-risk patients; that is those with indwelling or suprapubic catheters, complete lesions, >10 years since injury, bladder stones, or recurrent urinary tract infections

16. Treatment of Skin Breakdown
Assess for risk of pressure injuries using the Braden Scale, and refer to rehabilitation specialist if high risk

17. Treatment of Skin Breakdown
Treat stage I or II wounds with standard wound care. Treat stage III or IV wounds with specialist/surgical intervention

18. Depression and SCI
Screen for depression annually in patients with SCI, using the PHQ-9 or PHQ-2, and treat at standard guideline levels

19. Sexuality and SCI
Sexual activity, sexual function and reproductive issues should be addressed as part of an annual examination

20. Wheelchair Accessibility of Your Practice
Conduct an accessibility audit of your office space and procedures using attached Primary Care Accessibility Checklist