3.2 Other SCI issues Flashcards
apneic bradycardia
- slow HR (rapid decrease) with some loss of breathing
- happens when we do tracheostomy cleaning
stages of getting a tracheostomy
- first do oral intubation
- If it takes longer than 10-14 days to come off of the trach, they’ll do the tracheostomy hole through the throat
Why would they do a tracheostomy instead for prolonged cases?
- oral intubation keeps the vocal cords open
- prolonged opening can cause scarring and voice change
*partial or complete paralysis
cleaning secretions from trach
- long tube you can put down the trachea and suction things out
- bradycardia shouldn’t keep you from suctioning out
problems with a trach (nerve)
- vagus nerve runs near it - might trigger a vagal
- response that creates issues with heart
- don’t actually know why
bradycardia and trach
- just something that may happen, don’t freak out
- educate and monitor
Where do autonomics leave the spinal cord?
about at T6
injury below T6 and autonomics
wouldn’t affect autonomic nervous system
injury above T6 and autonomics
lesions from T6 and above are at risk for autonomic dysreflexia
What is autonomic dysreflexia?
- something below the level of the lesion throws off sympathetic and parasympathetic systems off
- body starts (somehow) perceiving sensation as noxious stimuli (they can’t feel it) and sends it up
What can cause autonomic dysreflexia?
- could be caused by a kinked catheter, ingrown toenail, wrinkle
- Sometimes, could be due to bladder distention, UTI, bowel impaction
BP and autonomic dysreflexia
- super high blood pressure
- may stroke out and die
autonomic dysreflexia: do patients get this multiple times? Is it dangerous?
- most patients who experience it will get it multiple times
- life threatening issue for patients
Where do s/s of autonomic dysreflexia start happening?
above the level of the lesion
s/s autonomic dysreflexia
- sudden increase in BP
- pounding headache
- flushing and perfuse sweating
- drippy nose
- sweating and goosebumps below the lesion
What should be done if a pt is showing s/s of autonomic dysreflexia?
- get help
- sit them up as soon as possible
Why wouldn’t you lay a person down who is having autonomic dysreflexia?
- opposite of orthostatic hypotension
- If you lay them down, their BP will increase
- do a full body exam to figure out what’s going on
thermoregulation: below the level of lesion
- below the level of the lesion, can’t sweat or shiver
- can’t feel temperature-wise
- no vasoconstriction/vasodilation
*typically cold
thermoregulation: para vs. quad
- paraplegics can do ok because core mass can help regulate
- quads are usually in warm clothes year round
thermoregulation and treatment considerations
- don’t want to treat them in a cold place
- burning a ton of calories to try to stay warm
What type of lesions cause spasticity?
UMN lesions
What can happen when patient repeatedly trigger spasticity to help control movement?
- can get myositis ossificans in their muscles from hitting them to trigger spasms
- lays down bone because it can’t heal tissue properly
Can SCI pts get spasms in muscles they have no control over?
yes
bad spasticity
- scissoring creates pressure on bony landmarks, bowel and bladder difficulty, transfers, etc
- If it’s really bad, will need med management
What type of lesions cause flaccidity?
LMN lesions
problems with flaccidity
- muscle wasting
- joint laxity
- contracture
- hypomobile or hypermobile
- osteoporosis
- fractures
- core muscles
- dependent edema
flaccidity: osteoporosis considerations
- lose bone mass (muscles no longer pulling on bones to strengthen)
- also not WB
- 1-1.5 years after injury, they typically lose 1/3 of bone mass
flaccidity: core muscle concerns
- breathing
- posture
- digestion
- can get kyphotic or scoliotic
flaccidity: dependent edema
- don’t have a muscle pump
- LE may have more swelling
