3.7 Spinal Cord Injury Management Flashcards
Describe initial evaluation of SCI in the field
- ABCD
- IF head injury, altered consciousness, spinal pain, loss of sensation, assume SCI
- Immobilize spine as much as possible
Describe initial clinical management of SCI in the ED
- Consider more immediate complications: pneumothorax, peritoneal bleeding etc.
- Ongoing monitoring of vital signs
- Consider intubation
- Immobilize neck until SCI is ruled out
Some patients with SCIs can enter neurologic shock, resulting in bradycardia and hypotension. How can the latter be managed?
- IV fluids
- Pharmacologic vasopressors
How do we avoid bladder distension initially in SCI patients?
Catheterization
List two mechanical treatments for traumatic SCI
- Surgery (depends on surgeon)
- Closed reduction
Is a positive Babinski sign a UMN or LMN lesion?
UMN
Describe deep tendon reflexes in upper vs lower motor neuron lesions
- Upper: Hyperreflexia
- Lower: Areflexia
Describe muscle tone in upper vs lower motor neuron lesions
- Upper: Spasticity/rigidity
- Lower: flaccid
What staff members might be involved in SCI rehab?
- OT
- Physio
- Social worker
- Speech path
- Psychologist
- Exercise physiologist
- Nurse
What factors might influence SCI rehab outcomes?
- Site of injury
- Complete/incomplete injury
- Intrinsic factors
- External support
How might be prevent pressure injuries during SCI rehab?
- Build upper body strength
- Education to carers
- Educate on weight shifting
- Pressure reliving cushions
- Regular skin checks/rolling
Why is it important to complete passive range of motion exercises during SCI rehab?
Prevent contractures from developing (retain mobility, and therefore independence)
What tasks might a patient identify for retraining purposes?
- Personal (showering, dressing, grooming)
- Instrumental (meal prep, shopping, laundry)
- Leisure (sex, sport, craft)
