Exam 2 Part 2 Flashcards
type of spinal cord injury:
damage that eliminated all innervation below injury =
complete
type of spinal cord injury:
injury allows some function below injury =
incomplete
*more common
causes of secondary SCI
- Hemorrhage
- Ischemia
- Hypovolemia
- Impaired tissue perfusion
- Edema
type of primary SCI
- Hyperflexion (head forward)
- Hyperextension (head backward)
- Axial loading / vertical compression
- Excessive rotation (twisting)
- Penetrating trauma
- Distraction (pulling head up from body)
type of sci: pulling head up from body =
distraction
CV involvement with SCI above … what does those CV changes look like?
T6 (bradycardia, hypotension, dysrhythmias)
Resp involvement with SCI above…
C3-c5
dermatome vs myotomes
derm = Zones of sensory motor function
myo= zones of muscle function
plegia vs paresis
plegia = paralysis
paresis = weakness
when does spinal shock occur and how long does it last?
-occurs immediately after injury
-lasts 48 hours to weeks
T or F: spinal shock results in temporary but complete loss of motor sensory reflex and autunomic function
true!
when and how do we use a quad cough
- use hands to push on their diaphragm when they breathe out
indication: secretions that cant be suctioned or reduced coughing ability
autonomic dysrefelxia occurs from sustained triggering stimuli at or below….
T6
stimuli that can cause autonomic dysreflexia =
◦ Full bladder / UTI
◦ Bowel distension, impaction, constipation
◦ Circumferential compression - thorax, abd, scrotum, or extremities
◦ Tight clothing
◦ Temp
◦ Pain / pressure
(7) sxs of autonomic dysreflexia:
- SNS- Increase in systolic and diastolic BP (sudden drastic increase in BP– risk for stroke!)
- Reflex Bradycardia - comes from increasing BP
- Severe HA
- Nasal congestion
- Diaphoresis (above injury) cold or goose bumps below
- Flush skin
- anxiety
non pharm intervenrtions for SCI
- spinal cord stabilization
- traction
- log roll
- surgery
- rehab
- no BLT
meds for SCI
- muscle relaxers
- steroids
- pain mangement
- BP manafgemnt
- stool softeners
special muscle relaxant we give for SCI?
‣ Intrathecal baclofen
‣ Given right at site of spinal cord injury
term, TBI:
- Sudden and profound injury to the brain
◦ GSW
◦ Blow to the head
◦ Fall - Considered “complete” at the time of impact
direct
term, TBI:
- Injury from force applied to another body part with rebound effect
- Movement of the brain w/i the skull
Ex
◦ Whiplash
◦ Rear end MCV
◦ Skane baby syndrome
indirect
causes of secondary TBI (4)
◦ Hypotension - MAP < 65
◦ Hypoxia PaO2 80-100
◦ Inc intracranial pressure (aka intracranial hypertension)
◦ Cerebral edema
ICP > ____ = neurons die
22
term, TBI:
- Skull fract or pierced
- Brain and dura contaminated
Ex
◦ Foreign obj penetration
◦ Linear
◦ Depressed
◦ Comminuted
◦ Basilar*
open
term, tbi:
* Skull maintains integrity
* Compilations with ICP
Ex
◦ Contusion
◦ Cerebral lacerations
closed
findings of basilar skull fracture:
- leaking CSF
- blood in ear
- ecchymosis behind ear (battle sign) or around eye
- loss of smell/hearing
- impaired facial nerve
mild vs moderate vs severe TBI: loss of consciousness
mild: disorient, loss of consc up to 3o min
moderate: loss of consc 30 min- 6 hour
severe: loss of cosc >6 hour
mild vs moderate vs severe TBI imaging
mild= no damage
moderate= focal or diffuse injury seen
severe = focal or diffuse in vessels or ventricles , can see injury early on
GCS moderate vs severe TBI
moderate = 9-12
severe = 3-8
who is going to ICU for ICP monitoring- mild, mod, or severe TBI?
severe
s/s of TBI
neuro changes, battle/raccoon eyes, muscle changes, visual changes, N/V, loc changes, halo sign
