Medical Management of SCI Flashcards
Phases of spinal shock
Phase 1: <24 hrs
decreased motor/sensory function below level of function & deep tendon, cutaneous, and sphincter reflexes
Phase 2: 1-3 days
Increased cutaneous reflexes
Phase 3: up to 1 month
Early hyperflexia
Phase 4: 1-12 months
Spasticity hyperflexia
Cardiorespritory Compromise
Sympathetic nervous system damage
During shock: bradycardia and hypotension
Distrupted innervation to diaphragm, intercostals and abs that can result in hypoxemia and hypercarbia
Immediate management goals
Secure airway
Circulatory support
Immobilize
Acute management goals (<24hrs)
ISNCSCI exam
Maintain MAP >85mmHg
Surgical decompression
Subacute-chronic
Mobilize!
Prevent pressure ulcers
Avoid triggers from AD
PT!
Diagnostic imaging
CT initially for bone
MRI for soft tissue injuries and epidural hematomas
What is tetraplegia
Paresis/paralysis in four limbs and trunk; lesion to cervical cord
What is paraplegia
Paresis/paralysis of LEs and part of all of trunk; lesion to thoracic/lumbar cord or caudal equina
AIS A
Anatomically complete: fully transected cord
AIS A-B
Clinically complete: complete loss of motor and/or sensory function
AIS C-D
Incomplete: some motor/sensory function below level of injury
Brown-Sequard Syndrome
Hemisection of spinach cord
Damage to corticospinal tract, fascicles gracilis, fascicles cuneatus, spinothalamic tract
Ipsilateral: loss of DCML
Contralateral: loss of ALS
Good prognosis for walking
Anterior Cord Syndrome
Damage to anterior portion of the spinal cord and/or vascular supply
Loss of motor function and ALS
PRESERVED DCML
Poor prognosis for return to bowel and bladder function, hand function and ambulation
Central Cord Syndrome
UE > LE impacted
Motor > Sensory impacted
Prognosis is good if hand function is spared, early motor recovery, LE motor preservation, and UE strength increases in rehab
Often seen in older adults from hyperextension injuries/falls
Posterior Cord Syndrome
Least common
Damage to DCML
PRESERVED motor and ALS
Conus Medullaris Syndrome
Damage to sacral cord and lumbar nerve roots
UMN and LMN signs:
saddle anesthesia
Bowel and bladder areflexia
LE weakness (BILATERAL but more mild)
Cauda Equina Syndrome
Damage to lumbosacral nerve roots
LMN ONLY
saddle anesthesia
Bowel and bladder areflexia
LE weakness (ASYMETRICAL)
Severe LBP
Fracture stabilization
Early decompression is key!
Surgical fusion or external stabilization (cervical orthoses and thoracolumbar orthoses)
Critical management
Methylprednisolone (systemic steroid therapy)
Blood pressure augmentation (MAP 85mmHg or > for 7 days)
Autonomic Dysreflexia (AD)
Most common with injuries at or above T6
EMERGENCY
A stimulus below the lesion level that triggers vasoconstriction and parasympathetic response ABOVE level of injury
Autonomic Dysreflexia (AD) s/s
Increased BP (compared to their new normal)
Bradycardia
Pounding headache
Flushing
Profuse sweating
Nasal congestion
Anxiety
Underlying causes of Autonomic Dysreflexia
Bowel and bladder issues
Skin breakdown
Ingrown toenail
Aggressive stretching
Muscle spasms
Surgical or diagnostic procedures
Treatment of Autonomic Dysreflexia
IMMEDIATE removal of noxious stimulus
SIT UP and LOWER LEGS
Check vitals
Get help!
No medications (they can mask s/s)
Early patient education is critical
Orthostatic Hypotension (OH)
Imbalance of sympathetic and parasympathetic NS
BP often drops with early mobilization
S/s: blurred vision, light-headedness, faintness
DVTs and PEs
Decreased/lack of mobility may cause development
DVT: pain, edema, erythema
PE: tachypnea, tachycardia, decreased O2 saturation, may see pink foamy mucus
Other complications (Biomedical Complications)
Respiratory: weak muscles and may be difficult to manage secretions
Urologic complications: dependency on catheters, UTIs, etc
HO
Pressure sores
Contractures: prevention is key!!
Osteoporosis and fracture
Rapid decrease in bone mineral density for the first several months but continues over years
Increased risk of fracture
Syringomyelia
Tapered fluid, filled cavity usually in upper levels of the cord
Initial loss of pain and temp sensation in the UEs and chest
Pain and parenthesis in UE, altered sensation and weakness
May also develop pain and spasticity in LE, ataxia
In severe cases paralysis can occur
Pediatric SCI injuries and age
Infants are prone to cervical injuries
Children 5-10 are prone to paraplegia (lap belt)
and Adolescents are prone to cervical
Children and ISNCSCI
Not reliable for <4 yrs old
Too complex for <8 yrs old
and Children <10 were distress during pin prick
Changes to children with SCI
Increased likelihood for obesity and metabolic syndrome
Decreased peak oxygen uptake
Decreased hip bone density
More at risk to be sedentary
