SCI Flashcards
does bony spinal injury equal SCI
no
primary injur
initial mechanical insult
secondary injury
post injury process - shock, electrolyte disturbances, toxicity
early management goals SCI
stabilise
limit deficit
promote recovery
non surgical options
bedrest
cervical collar
thoraclumbar colar
unstable spine goals
neutral spine, HOB at 0
prevent wounds and clear chest
stable spine goals
progression of mobility to upright / functional postures
T/f unstable spine is a 2-3 person turn at all times
true
stable but requires protection goals
turn and be neutral independently
must be neutral at all times
t/f patient may flex ext rotate within limits if no limts
yes
can you teach patient role to maintain neutral spine if no restrictions
yes
is sympathetic or parasympathetic chain longer
para - it starts higher - so initially after SCI people are para dominant
acute management - patient may be unable to manage their
BP
HR
temp
after SCI resting BP is __ than normal
lower
SCI clients don’t get __ but they have __
true tacky (>100bpm) relative tacky from baseline
need to watch if patients have __ due to __
fever
infection/sepsis
what can a change in reflexes indicate
no longer in spinal shock
S234 keeps
the poo off the flow
abomdinal function comes at
T6- LUMBAR
diaphragms comes at
C345
spinal shock
suppression of reflexes
may last weeks to months
neurogenic shock
loss of sympathetic control
injuries above t6
__ vasomotor tone causing __ in neurogenic shock
decreased
hypotension
hypotheremia
unopposed vagal nerve stimulation leads to __
bradycardia
untreated neurogenic shock can lead to __
metabolic acidosis
leading cause of death in acute SCI
respiration
__ of patients with C5 or higher require mechanical venticlation at some time , although most wean
95%
T/f respiratory failure is evident intially
no may develop over 3-5 days due to fatigue
External / internal intercostal
T1-11
SCM, scalene, traps, pecs, lats, erectors spinal, subalvis
CN X1, C1-8
C1-3 cough function C4 C5-T1 T2-4 T5-10 T11 and below
absent non functional non functional weak poor normal
C1-3 acute vital capacty C4 C5-T1 T2-4 T5-10 T11 and below
0-5% 10-15 30-40 40-50 75 to normal normal
C1-3 long term vital capacty C4 C5-T1 T2-4 T5-10 T11 and below
ventilator 50% of normal 60-70 60-70 nearly normal normal
how breathing different in SCI
paradoxical breathing
vital capacity and inspiratory volume greater in lying
decrease in all lung volume except residual volume
T/f easier for some Sci to breath laying down
yes
treatment options for trouble breathing
ventilator CPAP/BIPAP MIE stacked breathing secretion clearnce binders phrenic pacing
monitoring __ is important during acute stages to see changes in respiratory status
vital capacity
Peak expiratory flow
FEV1
a pounding headache is __ and light headache is
autonomic dsy
hypotension
ortho hypo
sudden 20 SBPdrop
10 drop in DBP
What to do for ortho hypo
stocking
binders
slow
meds
AD is cursed by __
sympathetic discharge
Ad is triggered by
noxious or non noxious stimulate below level of SCI
AD due to loss of __
supra spinal control
AD occurs in injury __
T6 and above
more commonly AD occurs in
chronic Sci, complete
symptoms of AD
increase in BP of 20-30 Brady poudnign headache cramps blurred vision paresthesia
signs of AD
dilated pupils goosebumps above injury pilorection sweating above dry cool below
common caused AD
full bladder wounds tight clothes sex painful stimuli
how to treat AD
upright
check BP
find triggers
loosen clothes
sensory exam scoring
2 normal
1 impaired
0 absent
motor exam scorin
0-5
neurological level of injury
most caudal segment with sensory and Motor antigravity mm function - with a 5 above it across both sides of the body
sacral sparing test
anal sensation s4/5
deep anal pressure
voluntary anal contraction 3 or more
if ANY of above, its incomplete
can physio do sacral sparing test
if you have training for internal exams
sensory incompleye
sacral sparing of lowest sacral segments s45
Asia B
motor incomplete
sacral spring of motor function
OR
motor function sparing more than 3 levels below with intact sensory sparing S45
key prognostic test
pin prick LE - 75% can walk a year later
Central cord syndrome
UE more effected than LE
hyperextension injury
low velocity injury
anterior cord syndrome
loss of motor function / pain below lesion
brown squared
ipsilaterally
paralysis, proprioception, vibration
contralterally
pain and temperatue
corticopsinal and dorsal cross at
brain
spinthalmic tract cross over at
SC
conus medularris you might get
mixed presentation ofUMN an LMN (flaccid and spastic)
cauda equina syndrome
injury below conus
LMN
c1-3 injury
qventilator dependent
overuse neck mm
dependent
c4 injury
may be able to breath without ventilate
bed mobility/ADL dependent
power w/c independent
c4 and above goals
inspirtaroy mm training
C5 injury
manual w/c possible
bed mobility / ADL some assist required
goals for c5
inspiratory mm training
ADL adaptive equipment
C6
have anti gravity wrist extention
may need some assistance, but can be ADL and ind
highest SCi level with some ind with or without equipment
c6
problem with c6
no triceps so to need to lock elbows for transfer
tendonesis grip
