Peds SCI

Question 1

Most common cause of Peds SCI

Answer 1

MVC

Question 2

AIS B

Answer 2

at least a degree of intact sensation below the neurologic level of injury an necessitates at least the sensation at S4-S5 or deep anal pressure.

Question 3

AIS C

Answer 3

motor incomplete- more than half the muscles below the neurological level of injury are LESS than grade 3

Question 4

AIS D

Answer 4

motor incomplete- more than half the muscles below the neurological level of injury are MORE than grade 3

Question 5

AIS E

Answer 5

normal exam after a previous abnormal examination

Question 6

Brown sequard syndrome

Answer 6

ipsilateral weakness and ipsilateral loss of vibration, position and light touch due to the corticospinal tract and dorsal column damaged that crosses in the brainstem. Contralateral pain and temp deficit due to lateral spinothalamic tracts damaged that crosses at the spinal cord.

Question 7

Risk factors for VTE in SCI

Answer 7

paralysis, lower ext fracture, chest injury, vascular injury,pelvic injury, head injury, central venous catheters, ICU stays >4 days, increased days in ventilator, high injury severity score, male, African American, complete paraplegia and 3 comorbidities.

Question 8

Consensus clinical practice guidelines on VTE prophylaxis in Peds SCI

Answer 8

Mechanical prophylaxis in every SCI. Anticoagulant in adolescents, specially if they have additional risk factors such as pelvic and lower ext fractures.

Question 9

Prognosis for SCI recovery

Answer 9

ASIA exam 72 hours after injury. AIS A, 0-5% will be functional ambulatory, mainly if lesions low thoracic or lumbar.
AIS B, 33% will be ambulatory
AIS C, 75%
AIS D 80-100%

Question 10

Higher level that can do transfer level surface

Answer 10

C6

Question 11

Higher level that can be independent

Answer 11

C7

Question 12

Risks of having an indwelling catheter long term

Answer 12

increased risk of UTIs, thickening of the bladder, incompetence of the sphincter and breakdown of the urethra.

Question 13

Voiding pressure of the bladder need to be maintained less than ___ cm H2O

Answer 13

40

Question 14

Antimuscarinic agents

Answer 14

Blocks the M2 acetylcholine receptor and relaxes the detrusor. Examples are oxybutinin, tolterodine, darifenacin and solifenacin.
Used to decrease bladder pressure.

Question 15

Colace

Answer 15

Stool softener

Question 16

Mineral oil

Answer 16

Stool softener

Question 17

Senna

Answer 17

Increases motility

Question 18

Bisacodyl

Answer 18

Increases motility

Question 19

Milk of magnesia

Answer 19

Draws water into the gut to stimulate motility

Question 20

Lactulose and polyethylene glycol

Answer 20

Draws water into the gut. Used for complete bowel emptying

Question 21

Autonomic dysreflexia

Answer 21

-Above T6 level
-Systolic blood pressure increase of 20-40mmHg from baseline
-Majority of cases occur until 3-6 months post injury
-In children the most common cause is urologic in nature.
Treatment- remove noscious stimuli (including bowel/bladder). Monitor BP every 3-5 min.- Transdermal 2% nitroglycerin paste and remove when adequate BP Is achieved. Nifedipine and captopril can also be considered.
If recurrent episodes terazosin and prazosin is used as prophylactic.

Question 22

Hypercalcemia in SCI

Answer 22

-Due to increased osteoclast activity and bone resorption.

Can present as early as 2 weeks, but is most commonly seen 4-16 weeks post injury.

Question 23

HO in SCI most common site

Answer 23

hip

Question 24

Treatment of HO

Answer 24

• Indomethacin for >15 days in high risks (ASIA A and B) for prophylaxis.
• Bisphosphonates for primary prevention and in early phase
• Low dose radiation
• Surgery

Question 25

Diagnosis of HO

Answer 25

Earliest detection with 3 phase bone scan