Lecture SCI - Secondary Pathologies Flashcards
2° Complications of SCI
Cardiovascular/Respiratory Integumentary Neurological Musculoskeletal Somatosensory GI/GU
Cardiovascular/Respiratory 2° Complications of SCI
6
Cardiac Arrhythmias Orthostatic hypotension Altered thermoregulation Autonomic Dysreflexia DVT/PE Respiratory Dysfn
Integumentary 2° Complications of SCI
Decubitus Ulcers
Neurological 2° Complications of SCI (2)
Spasticity
Syringomyelia
Musculoskeletal 2° Complications of SCI (4)
Osteoporosis
Fractures
Contractures
Heterotopic Ossification
Somatosensory 2° Complications of SCI (2)
Pain
Reflex Sympathetic Dystrophy
GI/GU 2° Complications of SCI
Bowel and Bladder Dysfunction
Altered Sexual Function
What is the single greatest factor leading to increase in hospital stay in patients with a spinal cord injury
Development of Decubitus ulcers
What type of WC would you use for a SCI and why would you not want the other kind
A tilt in space
Would not want a reliciner bc you would start sliding and will create a shear force
Cardiovascular Complications is from
Interruption btw receptor organs & brainstem
Interruption to ANS
Neurogenic Shock
What is the classic triad to neurogenic shock
- Hypotension –
due to loss of sympathetic tone (↓ systemic vascular resistance, & dilation of veins)
Hypovolemia (due to severe hemorrhage, inadequate fluid administration) - Bradycardia - heart less efficient and pumps slower - movement allows the heart to work a bit harder and pump better
- Hypothermia
What is Hypovolemia
Part of the classic triad of neurogenic shock
Due to severe hemorrhage, inadequate fluid administration
(Low volume)
How does orthostatic hypotension happen and what can be done to reduce it
orthostatic hypotension this can happen from supine to sitting bc you have an increase in demand in blood flow to the brain you make them move to make sure they dont pass out - the muscle pump is effective
Why would you use a tilt table?
to progressively help someone while they are sitting up
Graded upright positioning is the PT intervention of choice (i.e. ↑ HOB, recliners, tilt-in-space w/c, tilt table) 🡪 close BP monitoring!
If the tilt table doesn’t work to help orthostatic hypotension what else can be used?
compression garments
Pressure garments (TEDS & abdominal binders) May teach the Valsalva maneuver as preventative measure, but with much caution
How would someone present with Orthostatic hypotension
dizzy, pale and dry skin
Why do cardiac arrhythmias happen and what is the most common type
Also what makes it worse and when would it improve
Due to loss of sympathetic tone & unopposed vagal tone
Most common arrhythmia = Bradycardia
Worsened by stimulation of vagus n. (i.e. during tracheal suction, turning to prone, defecation)
Improves w/in a few weeks as spinal shock resolves
Which nerve is responsible for bradycardia and what does this nerve do
The vagus nerve
It is the longest of the cranial nerves, extending from the brainstem to the abdomen by way of multiple organs including the heart, esophagus, and lungs. Also known as cranial nerve X,the vagus forms part of the involuntary nervous system and commands unconscious body procedures, such as keeping the heart rate constant and controlling food digestion
How does the vagus nerve get stimulated
During tracheal suction, turning to prone, defecation
cardiac arrhythmias are due to
loss of sympathetic tone & unopposed vagal tone
What happens to thermoregulation with a SCI
it becomes altered
↓ thermoregulation below level of lesion
s/p SCI: the connection between the ANS & the cord is interrupted
How would a SCI pt present with altered thermoregulation
The patient will be unable to sweat when warm or shiver when cold below the level of the lesion
How does normal thermoregulation happen
Hypothalamus sends impulses via autonomic pathways to the cord, then through sympathetic outflow to the skin, initiating compensatory reactions to ↑ or ↓ temperature
Why do you have to make sure people are aware of altered thermoregulation
The higher the lesion, the greater the proportion of the body that is unable to maintain safe temperature