Nurb test 2: spinal injury Flashcards
- Many patients remain independent
- 90% are discharged to their home-hospital stay 3-4 weeks, rehab 40 days
- 10% are discharged to nursing homes, chronic care facilities, or group homes
- Young adult men between ages 16 and 30 are at greatest risk: dare devils, risk takers
- Affects every system in the body, psychological aspect is devastating
spinal cord injury
Ongoing, progressive damage that occurs after initial injury=can spread from initial injury
- Secondary injury
A. area of injury
B. Inflammation
C. Vasoconstriction= clot formation to stop bleeding
D. migration = causes edema, presses on spinal cord, less oxygen to the area, potential for more death
Initial Injury
-50%, complete loss of all reflexes, sensation, completely flaccid below the injury, wait for it to run its course 1-6 weeks, may have a little movement
Spinal Shock
- gradually wears off may still have low bp may take 6 months
- the person loses sympathetic control to a degree, but maintains parasympathetic=lowers, dilates
- body can’t communicate
Manifestations: hypotension, orthostatic, bradycardia
Neurogenic Shock
- Try to predict the highest level of the function
1. Mechanism of Injury
2. Level of injury
3. Degree of injury
Classification of Spinal Cord Injury
mechanisms of injury
flexion hyperextension penetrating compression flexion-rotation
- pushing neck forward, hurt spinal cord posteriorly
Flexion
-injury or fall hit h=chin and neck is pushed backed, tearing in anterior location
Hyperextension
- from fall, pressure directly on head Ex: dive hit head, or hit bottom
Compression
- tearing on one side
Flexion-rotation
- gunshot or stab that goes into spinal cord
Penetrating
- Injury is the vertebral level where there is most damage to vertebral bones and ligaments
Skeletal level
-Lowest segment of spinal cord with normal sensory and motor function on both sides of the body, may not match skeletal level
Neurologic level
resp center not compatable with life, die initially
Cervical 1-3:
portable ventilator, affects intercostal and diaphragm breathing still effected
Cervical 4:
: a little shoulder movement, move elbow, no fine motor mov, better resp reserve
Cervical 5
care- work electric wheel chair- hand control, able to feed self, participate self care, some type of attended care 10 hours a day
cervical 5
Care- electric wheel chair with chin control, 24 hour care home or facility= bc vent
cervical 4
- better flexion with elbow and bicep control, have a thumb grasp
Cervical 6
Care- can drive a wheel chair van, can type on the computer, 6 hours a day of attended care= can be home health
cervical 6
finger control, ability flex and extend, ability to grasp
Cervical 7-8-
Care- transfer independently=slide board, roll self, maybe sit up some, care is 0-6 hours
cervical 7-8
paraplegic not quad.
Vertebra 6-12:
- Total loss of sensory and motor function below level injury
Complete cord involvement
Mixed loss of voluntary motor activity and sensation and leaves some tracts intact, may have pain but no temperature
Incomplete (partial) cord involvement-
central cord syndrome anterior cord syndrome bronw sequard syndrome posterior cord syndrome causda equina syndrome conus medullaris syndrome
6 syndromes with incomplete leisions
-area of the cord, central part
Sx: lose motor function, worse in upper extremities
Central cord syndrome