Medical Management of SCI

Question 1

Phases of spinal shock

Answer 1

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

Question 2

Cardiorespritory Compromise

Answer 2

Sympathetic nervous system damage

During shock: bradycardia and hypotension

Distrupted innervation to diaphragm, intercostals and abs that can result in hypoxemia and hypercarbia

Question 3

Immediate management goals

Answer 3

Secure airway
Circulatory support
Immobilize

Question 4

Acute management goals (<24hrs)

Answer 4

ISNCSCI exam
Maintain MAP >85mmHg
Surgical decompression

Question 5

Subacute-chronic

Answer 5

Mobilize!
Prevent pressure ulcers
Avoid triggers from AD
PT!

Question 6

Diagnostic imaging

Answer 6

CT initially for bone
MRI for soft tissue injuries and epidural hematomas

Question 7

What is tetraplegia

Answer 7

Paresis/paralysis in four limbs and trunk; lesion to cervical cord

Question 8

What is paraplegia

Answer 8

Paresis/paralysis of LEs and part of all of trunk; lesion to thoracic/lumbar cord or caudal equina

Question 9

AIS A

Answer 9

Anatomically complete: fully transected cord

Question 10

AIS A-B

Answer 10

Clinically complete: complete loss of motor and/or sensory function

Question 11

AIS C-D

Answer 11

Incomplete: some motor/sensory function below level of injury

Question 12

Brown-Sequard Syndrome

Answer 12

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

Question 13

Anterior Cord Syndrome

Answer 13

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

Question 14

Central Cord Syndrome

Answer 14

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

Question 15

Posterior Cord Syndrome

Answer 15

Least common

Damage to DCML

PRESERVED motor and ALS

Question 16

Conus Medullaris Syndrome

Answer 16

Damage to sacral cord and lumbar nerve roots

UMN and LMN signs:
saddle anesthesia
Bowel and bladder areflexia
LE weakness (BILATERAL but more mild)

Question 17

Cauda Equina Syndrome

Answer 17

Damage to lumbosacral nerve roots

LMN ONLY
saddle anesthesia
Bowel and bladder areflexia
LE weakness (ASYMETRICAL)
Severe LBP

Question 18

Fracture stabilization

Answer 18

Early decompression is key!

Surgical fusion or external stabilization (cervical orthoses and thoracolumbar orthoses)

Question 19

Critical management

Answer 19

Methylprednisolone (systemic steroid therapy)

Blood pressure augmentation (MAP 85mmHg or > for 7 days)

Question 20

Autonomic Dysreflexia (AD)

Answer 20

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

Question 21

Autonomic Dysreflexia (AD) s/s

Answer 21

Increased BP (compared to their new normal)
Bradycardia
Pounding headache
Flushing
Profuse sweating
Nasal congestion
Anxiety

Question 22

Underlying causes of Autonomic Dysreflexia

Answer 22

Bowel and bladder issues
Skin breakdown
Ingrown toenail
Aggressive stretching
Muscle spasms
Surgical or diagnostic procedures

Question 23

Treatment of Autonomic Dysreflexia

Answer 23

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

Question 24

Orthostatic Hypotension (OH)

Answer 24

Imbalance of sympathetic and parasympathetic NS
BP often drops with early mobilization

S/s: blurred vision, light-headedness, faintness

Question 25

DVTs and PEs

Answer 25

Decreased/lack of mobility may cause development

DVT: pain, edema, erythema
PE: tachypnea, tachycardia, decreased O2 saturation, may see pink foamy mucus

Question 26

Other complications (Biomedical Complications)

Answer 26

Respiratory: weak muscles and may be difficult to manage secretions

Urologic complications: dependency on catheters, UTIs, etc

HO

Pressure sores

Contractures: prevention is key!!

Question 27

Osteoporosis and fracture

Answer 27

Rapid decrease in bone mineral density for the first several months but continues over years

Increased risk of fracture

Question 28

Syringomyelia

Answer 28

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

Question 29

Pediatric SCI injuries and age

Answer 29

Infants are prone to cervical injuries
Children 5-10 are prone to paraplegia (lap belt)
and Adolescents are prone to cervical

Question 30

Children and ISNCSCI

Answer 30

Not reliable for <4 yrs old
Too complex for <8 yrs old
and Children <10 were distress during pin prick

Question 31

Changes to children with SCI

Answer 31

Increased likelihood for obesity and metabolic syndrome
Decreased peak oxygen uptake
Decreased hip bone density
More at risk to be sedentary