Palliative Emergencies Flashcards
Prognosis of spinal cord compression
If pt ambulates well prior to Tx, 80% chance of recovery, If didn’t ambulate, less than 10% of walking again. Loss of ambulation associated with shorter prognosis
Spinal cord stenosis location
70% at the thoracic level. In 30% of the cases there are multiple levels of cord compression. (thus mri of the total spine is needed)
Clinical features of spinal cord compression
- Pain often precedes the development of neurological deficits, however pain might be absent.
Pain maybe localized to the culprit vertebral region, with tenderness to percussion.
Also possible - radicular pain unilateral or bilateral from nerve root compression.
Pain may be aggravated by movement neck flexion and leg raising. - Neurological deficits. Lesions above L1 level will produce upper motor neuron signs (motor weakness was increased reflexes and increased tone).
Lesions below this level produce a cauda equina syndrome with lower motor neuron signs (flaccid weakness and decreased reflexes) with possible perianal numbness.
Sensory deficits such as parasthesia follow a dermatomal pattern. Loss of sensation is more pronounced with light, sharp and cold touch.
Autonomic function, specifically bladder and bowel control, occurs late in the evolution of spinal cord compression above L1 on L2, in cauda equina may occur earlier.
Initial treatment spinal cord compression
-do not delay treatment
-start corticosteroids immediately
(dexa 10 sc/iv)
After mri move forward with definitive Tx.
-dex 24-40mg /day sc /oral, given in divided doses, tid /qid
Seizure TX
Initial options:
- Midaz 5-10 mg sc /im /iv. IM faster than sc.
- Lorazepam 2-4mg sc/iv
- diazepam 10 mg pr /iv (pr needless syringe).
Repeat every 10 mins if needed.
For refractory / repeated seizures :
Phenobarbital 100 mg sc rate 50mg/min or slow iv 100 mg in 100 ml 0.9% NaCl .
Continues infusion 200 - 600mg /24hr.
