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Spinal Cord Injury
slide notes
| Question | Answer |
|---|---|
| What is the prevalence of spinal cord injury? | 10-12,000/yearly |
| What is the major cause of death for spinal cord injury patients? | Pneumonia/PE or Septicemia |
| Pathophys of SCI? | Primary injury: initial mechanical insult usually irreversible. Secondary injury: usually triggered by spinal cord ischemia. Tissue injury response of Hypoxia, Edema and Ischemia. |
| Types of SCI? (Compression/Hyperflexion) | COMPRESSION: FALLS FROM HEIGHTS, IE. CAUSES VERTICAL FORCE ALONG SC-> MAY CRUSH OR COMPRESS PIECES OF VERTABRAE OR BONEY PARTS INTO SC. TOP INJURY TO CERVICAL AREA HYPERFLEXION- HEAD ON COLLISION-> HEAD HYPERFLEXED FORWARD THEN SNAPPED BACKWARD |
| Types of SCI? (Hyperextension/Rotation) | HYPEREXTENSION-> MVA’S-SC STRETCHES DISTORTED. BACKWARD-> DOWNWARD MOTION OF HEAD. THORACIC/LUMBAR AREAS MOSTLY AFFECTED. MAY HAVE NEURO DEFICITS DUE TO CONTUSIONS AND ISCHEMIA TO SC, NOT NECESSARILY BONEY ISSUES. ROTATION-> SEVERE ROTATION OF HEAD &/OR |
| SPINAL CORD VERTEBRAE | CERVICAL SECTION 1-7 neck THORACIC SECTION 1-12 upper back LUMBER SECTION 1-5 lower back SACRAL SECTION 1-5 hip area COCCYGEAL 1-4 fused tailbone |
| Tx/mgmt of SCI ? | Stabilization to prevent further injury Standard transport is C collar/backboard ABC’S Diagnostic testing: CT MRI X-RAY etc. Nonsurgical: HALO, ROTOREST Traction: Corsets Braces Shells Surgical: Laminectomy C1-C5 usually needs intubated Fluids-mai |
| TESTS | X-RAY: R/O Fractures or dislocation of vertebrae and spinal processes. CT: anatomy of bone and assessing neurological symptoms & or pain. MRI: Visualization of cord and spinal cord and nerve roots Physical assessment Injury below t6 usually hemorrh |
| MEDICATION | Methylprednisolone (Solu-medrol)-Controversial because of side effects Anticoagulants Vasopressors- for BP Blood products- due too internal injuries IV FLUID-keep bp stable |
| What is spinal shock? | Temporary loss of SC function Non-Preventable T6 and above Neuronal injury 50% will get this, it’s temporary so need to wait to assess |
| What is neurogenic shock? | Hemodynamic instability Triad:Hypotension,Bradycardia,Temperature instability (Poikilothermia) body assumes room temperature |
| Cardiac: arrythmias/bradycardia SCI | Esp in cervical injuries: Injury or interruptions to the cardiac accelerator nerves can cause B/P instability, and arrhythmias. Tachycardia or bradycardia can occur. R/O hypovolemic shock ( heart rate would be tachy) |
| Cardiac :orthostatic hypotension SCI | Low B/P may be caused by pooling of blood in small arteries away from the heart, due to loss if tone in blood vessels-> treated with IV fluids to increase blood volume |
| Cardiac: DVT/PE SCI | Blood clots-> 3x’s the risk after 72 + hours post injury-> Consider anticoagulation therapy. |
| Cardiac :Altered thermoregulation SCU | Sympathetic nervous system interruptions above T6-7 can cause a loss in autoregulatory control of B/P (get hypotensive can last for months) and temperature. The body is unable to sweat or shiver so can’t control it’s temperature. Peripheral dilation makes |
| GASTROINTESTINAL SCI | Most develop ileus due to spinal shock NPO NG tube Ulcers Metabolic Stress Syndrome-may need high caloric supplements. When in rehab: calorie count |
| GU: Neurogenic Bowel | Injury level above T12 (UMN) Reflex : Brain doesn’t get the message bowel is full. Sphincter muscle tight. Bowel empties by reflex(reflexic) Bowel program: Diet, Stool Softeners, Suppositories and or Digital Stimulation |
| GU- BOWEL | Injury level below T12 (LMN) Flaccid Bowel: Doesn’t get message, reflex doesn’t work, sphincter (anal) muscles stay relaxed (areflexic). Bowel program: Suppositories, Digital stimulation or disempaction. Start every other day. |
| Bowel Teaching | Try to train bowel. Do program same time each day. Sit if possible: gravity Commode: not bedpan IF side laying: Left side Long term: may lead to Colostomy |
| Neurogenic GU/Bladder | UTI and renal dysfunction are long term causes of morbidity & mortality At time of injury most have foley placed SCI bladders: REFLEX or FLACCID Reflex (autonomic or spastic) above T12 Treatment: ICP, Indwelling or condom cath catherization every 4 ho |
| GU/BLADDER | Flaccid bladder: T12 and below (non-reflex). Treatment ICP preferred. Dyssynergia: spincter muscle stays contracted when bladder contacts. Treatment: medications or surgery |
| AUTONOMIC HYPERREFLEXIA | AUTONOMIC HYPERREFLEXIA The most common medical emergency can lead to stroke->death The most life threatening condition of SCI T6 and above. |
| Autonomic dysreflexia | Occurs when a noxious stimuli triggers intact sensory nerves below the level of injury. Unique to SCI Precipitating factors: Bladder/Bowel distention. Pressure or irritation (esp: genitals) constricted clothing. |
| Autonomic dysreflexia -above and below injury | Above level of injury: flushed skin, profuse perspiration Below level of injury: cool, pale skin, Goos |
Created by:
UARN85
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