SCI Flashcards
What are the two things that determine spinal cord injury?
Mechanism of injury and location of trauma
What is primary injury vs secondary injury?
Primary = result of initial trauma
Secondary = result of ischemic/hypoxia/hemorrhage that destroys nerve tissues
For how long is secondary injury preventable for SCI?
first 4-6 hours after injury
What are the 6 types of injury that can cause SCI?
- fractures
- dislocations/subluxations
- flexion injuries
- extension injuries
- compression injuries
- axial rotational injuries
What type of injury is highly unstable and often occurs when patient falls on their head?
Axial rotational injuries
What injury causes vertebral bones to shatter or burst, and often occurs with blow to top of head or landing forcefully on feet?
Compression injuries
What injury is caused by backward bending of spinal column, e.g. fall when chin is point of impact?
Extension injuries
What SCI injury is most common and is caused by forward bending of spinal column e.g. head struck from behind?
Flexion injuries
What is quadriplegia defined by?
Patient with cervical level injury (C1-C7)
What is paraplegia defined by?
patient with injury from thoracic level (T1-T12) through to sacral level (S1-S5)
SCI Function varies depending on what?
vertebrae involved, e.g. injury to C1 vs injury to S5
Intermediate interventions for SCI?
- ABC’s
- immobilise spine
- intubate/vent if needed
ED interventions for SCI?
- give steroids
- monitor for neurogenic and spinal shock
Example of an IV Corticosteroid used to treat SCI in ED?
Methylprednisolone
Neuro interventions for stabilised SCI?
- halo traction
- spine fusion
- neck brace/collar
- assess q4h
Respiratory interventions for stabilised SCI?
- trach care as needed
- lung sounds
- suctioning
- quad coughing
Mobility interventions for stabilised SCI?
- active/passive ROM
- maintain body alignment
- increase HOB
bowel/bladder function interventions for stabilised SCI?
- pt may initially have paralytic ileus, may use NG tube to decompress
- high fiber diet
- stool softeners
- bladder program
- intermittent cath q6h
Describe the SCI complication spinal shock?
absence of voluntary and reflexive activity below level of injury, lasts days-months
Describe the SCI complication neurogenic shock?
-hemodynamic phenomenon including loss of vasomotor tone
- occurs within 30 min of injury T5 or above
- lasts up to 6 weeks
Symptoms of spinal shock?
- decreased reflexes
- loss of sensation
- flaccid paralysis below injury
Symptoms of neurogenic shock?
- hypotension
- bradycardia
- poikilothermia
Intervention for neurogenic shock?
- airway support
- fluids PRN
- atropine for bradycardia
- vasopressors for BP
Describe the SCI complication autonomic dysreflexia?
excessive uncontrolled sympathetic response, usually from noxious stimuli, occurs with SCI above T6
Symptoms of autonomic dysreflexia?
- severe HA
- increase in BP
- sweating
- blurry vision
- nausea
- nasal congestion
Interventions for autonomic dysreflexia?
- sit pt up
- call MD
- antihypertensives
Describe the SCI complication spasticity?
Increase in reflex activity and spasms, triggered by movement, pain, bladder etc.
Symptoms of spasticity?
muscle spasms, increased reflex activity
Interventions for spasticity?
medication, rehab program e.g. exercise, stretching
What antihypertensive medications could be used to treat autonomic dysreflexia?
NTG, Apresoline, Prazosin
What medication could be used to treat spasticity?
Baclofen
