SPI Flashcards
Classification of SPI
Complete and incomplete
Complete Spinal
Damage eliminates all nerve innervation below the level of injury
Incomplete Spinal
Still allows some fx or movement below the area of injury
Types of Trauma/ Injury
Primary and secondary
Primary Injury
Hyperflexion Hyperextension Axial loading or cord compression Excessive Rotation Penetrating trauma
Excessive Rotation
Rotation of head beyond normal range
Hyperflexion
Head forcefully accelerated forward causing extreme neck flexion
Hyperextension
head forcefully accelerated back then decelerates
Axial loading or cord compression
excessive force drives wt of body against head and causes compression of spinal cord
Secondary SPI
Hemorrhage
Ischemia
Neurogenic shock
Spinal shock
C1- C3
Needs ventilator support to survive
C4
No control of arms
C5-C6
Some movement of arms
C7
possible to transfer self independently
C8
Movement of fingers along with arms; able to do more complex skills
Secondary Injury: Cord Edema
Injury causes microscopic bleeding and inflammatory rx
peaks in 2-3 days , subsides around 7 days
Edema often extends to - 2 cord segments above and below site of injury
Difficult to determine degree of impairment
Secondary Injury: Spinal Shock
Complete, but temporary loss of motor fx, sensory, reflex and autonomic fx below level of injury
Results in flaccid paralysis, no refelxes (bladder bowel)
May last a few days.. or weeks
Return to reflexes indicates that spinal shock is resolving
Absence of ALL voluntary and reflex neurologic activity below level of injury
> v reflexes
> loss of sensation
> flaccid paralysis below injury
Secondary Injury: Neurogenic Shock
Loss of Sympathetic vascular tone = v sympathetic impulses to blood vessel smooth muscle and results in peripheral dilation and pooling of peripheral blood.
Hypotension
Bradycardia
Unstable temp
occurs within 30 min cord injury at level T5 or above and lasts up to 6 wks
Management of Neurogenic shock
Airway support iv fluids NS Atropine for bradycardia Vasopressors: norepinephrine Keep Map above 80-85, adequate UOP Supine position Active warming as needed
Pre-hosptial care
1 thing:cervical collar
Remember ABCs
C4 and above needs ventilator support
Jaw Thrust, not head tilt
Criteria for spinal immobilization
- MOI
- spinal tenderness, AMs, LOC, neuro deficit, and intoxication
Recognize potential for other injuries
- Head, chest, abdominal, extremity injuries
ER care
- Spinal x-rays (neck down)
- CT head/spine
- MRI to visualize cord
LABS
ABG, CBC, CMP
Serial H/H if potential blood loss (q 4 or 8)
Initial TX
Cervical -maintain spinal precaustions -cervical neck collar -log rolling -halo INSPECT PIN SITES FOR INFECTION Thoracic/ Lumbar -Thoracic TLSO (made for their bodies)
SCI TX
Prevent pressure sores
- may not feel pain
- repostion
Paralytic illeus
antiemtics
NG tube PRN
Beyond the ED
Admit to ICU or SC unit
ongoing management
- ventilator > trach prn
- be alert for decreased rest fx as more proximal spinal segments are affected as edema worsens
- Prevent aspiration, atelectasis, pneumonia
onging management of spinal shock
Surgical management
Stabilization -fusion of vertebra -insertion of rods or other fixation Decompression of cord -removal of fluid, tissue, bone fragments
Methylprednisone
Steroid
Bolus given iV within first 8 hr of injury, followed by drip for first 24 hrs to decrease initial inflammatory process
decrease inflame because suppressed immune system
