Peds SCI Flashcards
Most common cause of Peds SCI
MVC
AIS B
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.
AIS C
motor incomplete- more than half the muscles below the neurological level of injury are LESS than grade 3
AIS D
motor incomplete- more than half the muscles below the neurological level of injury are MORE than grade 3
AIS E
normal exam after a previous abnormal examination
Brown sequard syndrome
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.
Risk factors for VTE in SCI
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.
Consensus clinical practice guidelines on VTE prophylaxis in Peds SCI
Mechanical prophylaxis in every SCI. Anticoagulant in adolescents, specially if they have additional risk factors such as pelvic and lower ext fractures.
Prognosis for SCI recovery
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%
Higher level that can do transfer level surface
C6
Higher level that can be independent
C7
Risks of having an indwelling catheter long term
increased risk of UTIs, thickening of the bladder, incompetence of the sphincter and breakdown of the urethra.
Voiding pressure of the bladder need to be maintained less than ___ cm H2O
40
Antimuscarinic agents
Blocks the M2 acetylcholine receptor and relaxes the detrusor. Examples are oxybutinin, tolterodine, darifenacin and solifenacin.
Used to decrease bladder pressure.
Colace
Stool softener
Mineral oil
Stool softener
Senna
Increases motility
Bisacodyl
Increases motility
Milk of magnesia
Draws water into the gut to stimulate motility
Lactulose and polyethylene glycol
Draws water into the gut. Used for complete bowel emptying
Autonomic dysreflexia
-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.
Hypercalcemia in SCI
-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.
HO in SCI most common site
hip
Treatment of HO
- 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
