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PT644 > SCI Acute Care > Flashcards

SCI Acute Care Flashcards

1
Q

What is the goal of early surgical decompression?

A

Improve blood flow and decrease the expansion of the zone of secondary injury

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2
Q

What is early surgical decompression associated with?

A

Decreased medical complications and decreased hospital stay

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3
Q

What is the prognosis of early surgical decompression?

A

Patients are 2.8x times more likely to improve 2 AIS grades 6 months after injury if early surgical decompression is performed less than 24 hours after injury

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4
Q

What is the goal of methylprednisolone?

A

Upregulation of anti-inflammatory cytokine release and decreased oxidative stress

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5
Q

Why is methylprednisolone controversial?

A

It resulted in an increase in sepsis and pneumonia when given for 48 hours after injury in the past.

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6
Q

What is the current recommendation for the administration of methylprednisolone?

A

Given between 8 hours and 24 hours after injury

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7
Q

What is methylprednisolone associated with?

A

Improvement of 4 motor points on the ASIA exam and fewer medical complications

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8
Q

What are the primary respiratory goals?

A

Improves ventilation
Increased effectiveness of cough
Prevention of chest tightness
Prevent ineffective substitute breathing patterns

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9
Q

What does respiratory management consist of?

A 
Diaphragmatic breathing
Diaphragm PREs
Productive cough
Assisted coughing
Abdominal binder
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10
Q

Steps of medical management of acute injury

A

Immobilization at scene of accident
Maintain systolic BP greater than or equal to 90 mmHg for 7 days after injury
Once stabilized, ASIA exam to determine level of injury and completeness
CT scan. MRI as well if mechanism is unexplained
Transport to specialty center if SCI is established

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11
Q

How does one immobilize the patient at the scene of the accident?

A

With stiff cervical collar and supportive blocks on a backboard

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12
Q

What is maintaining BP greater than or equal to 90 mmHg for 7 days after injury associated with?

A

Improved AIS outcomes

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13
Q

Motto for early surgical decompression?

A

Time is spine

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14
Q

What are harrington rods typically used for?

A

Scoliosis

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15
Q

What is used for surgical spine stabilization?

A

Bone graft and/or hardware and orthosis

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16
Q

Difference between Minerva and SOMI braces compared to Gardner-Wells tongs and Halos

A

Minerva and SOMI braces are used for less severe cases that need immobilization but not as much traction

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17
Q

What are the 3 thoracic and lumbar stabilizers discussed in class?

A

Jewett Brace
Custom TLSO
Knight-Taylor Brace

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18
Q

What are the 3 points of support on the thoracic and lumbar stabilizers?

A

Sternum
Pubic symphysis
Back

19
Q

What is the most stable of all the thoracic and lumbar stabilizers discussed in class?

A

Custom TLSO

20
Q

How often should patients with SCI learn to change positions when laying down?

A

Every 2 hours

21
Q

How many positions do patients with SCI have to switch through in order to prevent skin breakdown?

A

3-5 positions

22
Q

What positions do patients with SCI switch through in order to prevent skin breakdown?

A

Supine, 30-45 deg R+L, side-lying R+L

23
Q

What does the chest do during normal inspiration?

A

Elevates and expands

24
Q

What does the abdomen do during normal inspiration?

A

Distends

25
Q

What does the chest do during normal expiration?

A

Drops and contracts

26
Q

What does the abdomen do during normal expiration?

A

Caves

27
Q

Exercises for deep breathing

A

Manually resisted inspiration and expiration

Incentive spirometry from HEP

28
Q

Coughing technique

A

Take deep breath
Turn head, cough twice
Expel secretions on second cough

29
Q

Assisted cough technique

A

Place hands over diaphragm with fingers interlocked and elbows straight
Push/scoop up (timed correctly with patient)
Avoid ribs and xiphoid

30
Q

What are 2 ways the patient can assist themselves when coughing?

A

Self-assist with wrists or pillow

31
Q

What are the instructions for the patient to self-assist when coughing?

A

Sit erect in w/c
Place both wrists in abdomen or pillow on lap
Take deep breath
Throw yourself onto wrists while pulling up and in while coughing
(For pillow, just throw self onto pillow)

32
Q

When should orientation to vertical be introduced?

A

After radiographic union and MD clearance

33
Q

Why use tilt table?

A

Because the patient might be on restrictions after their spinal surgeries and they may not be able to flex their legs enough to get themselves into the seated position

34
Q

How do you implement the tilt table?

A

Gradually progress to prevent OH. Do not exceed 70 deg tilt

35
Q

Why encourage good posture during w/c sitting?

A

To prevent malalignment and to put the body in optimal position for efficient breathing

36
Q

What is another reason to encourage good posture for patients with high SCI with no trunk control?

A

To prevent the trunk extensors and ligaments in the lower back from shortening when the patients body is in an elongated position. When they shorten in a shortened trunk position, it provides the patient with a mechanical advantage to be able to do bed mobility and transfers

37
Q

What can cause sacral-sitting?

A

Sling seats and sling back on w/c

38
Q

Pressure relief starts with…

A

w/c cushion

39
Q

How often should pressure relief be done?

A

10 seconds every 10-15 mins

40
Q

2 ways in which someone with paraplegia or low quadriplegia can perform pressure relief

A

Push-up with hands on arm rest, wheels, or push rims

Wheelie resting position

41
Q

What is a tool necessary for skin inspection?

A

Long handled mirror

42
Q

Where should a patient with SCI inspect their skin?

A

At sacrum and coccyx
Ischial tubes
Heels

43
Q

What are the general principles of progression of treatment activities?

A 
Assume the position
Maintain the position
Weight shift in position
Transition into and out of the position
Move from one position to another in the position

PT644 (20 decks)

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