SPINAL CORD INGURY Flashcards
1
Q
ANATOMY REVIEW
A
- the spinal cord runs through the vertebral column with spinal cords extending out into the body
- 31 pairs of spinal nerves
- 33 vertebrae in total
2
Q
THE VERTEBRAE
A
- when talking about SCI we identify the level of injury by the vertebrae
- Cervical(c1-c7)
- Thoracic (t1- t12)
- Lumbar ( l1-l5)
- Sacrum (s1- s5)
- not usually numbered all 5 are fused
-Coccyx (co1-co4)
not usually numbered all 4 are fused
3
Q
SCI
A
- approximately 12,000 new incidents per year
- plurality are related to auto mobile accidents
- falls account for the second highest incidence
- biggest at risk is men , young adults (16-30) Caucasians
- most occur C1-5, T12, L1-3
4
Q
PATHO
A
- initial trauma which kills neurons, initiates inflammatory response
- reduced blood flow due to trauma, swelling, edema
- compression due to swelling from injury and inflammation
- WBC’s bleeding into spinal cord causing more inflammation cytokine release may lead to scar tissue formation
- early intervention and treatment can help limit degree of damage to spinal cord
5
Q
ETIOLOGY
A
-excessive force to the spinal column in one of several ways
6
Q
HYPERFLEXION
A
bend neck forwards
7
Q
HYPEREXTENSION
A
bend neck backwards
8
Q
COMPRESSION
A
landing on head or butt
9
Q
ROTATIONAL
A
bend neck to side or turn to side
10
Q
TRANSSECTION
A
partial or complete severance
11
Q
CLASSIFICATIONS
A
- clinical signs, symptoms , treatment , etc depend partially on type of SCI
- type of injury (flexion , transection)
- skeletal LOI (vertebrae, C5, T11, )
- neurological LOI ( more or less same as vertebrae numbering except for c8)
- completeness or degree of injury
12
Q
GRADE A
A
complete no sensory or motor function preserved in sacral segments S4-S5
13
Q
GRADE B
A
incomplete, sensory but not motor function preserved below the neurologic level and extending through sacral segments S4-S5
14
Q
GRADE C
A
incomplete, motor function preserved below the neurologic level , majority of key muscle have a grade <3
15
Q
GRADE D
A
incomplete, motor function preserved below the neurologic level, majority of key muscles have a grade >3
16
Q
GRADE E
A
normal motor and sensory function
17
Q
TYPES OF SCI’S
A
-COMPLETE -total loss of function below level of injury
INCOMPLETE- some feeling or movement remains
- central cord
- anterior cord
- posterior cord
- brown sequard syndrome
- conus medullaris syndrome and cauda equina
18
Q
CENTRAL CORD
A
-damage to center of spinal cord
- more severe motor loss in upper extremities
than lower extremities - bladder dysfunction (retention)
- almost all will have some degree of recovery , usually starting in lower extremities
19
Q
ANTERIOR CORD
A
- damage to anterior 2/3 of cord
- loss of function below level of injury
- loss of pain , temp sensations
- keep proprioception
- poor prognosis, some motor recovery may be possible
20
Q
POSTERIOR CORD
A
- very rare, damage to posterior portion of spinal cord
- most have good motor, pain, and temp control
- mainly loss of proprioception , light touch
21
Q
BROWN -SEQUARD SYNDROME
A
- hemisection of spinal cord
- same side motor paralysis, loss of proprioception below LOI
- opposite side loss of pain and temp sensation below LOI
- best prognosis , majority will be able to ambulate independently eventually with treatment
22
Q
CONUS MEDULLARIS SYNDROME AND CAUDA EQUINA
A
- injury to tapered end of spinal cord (L1 , rarely L2)
- not a true SCI, injury to spinal nerves branching from spinal cord
- partial or complete loss of sensation below LOI, saddle anasthsia, sciatica, low back pain
- “saddle anesthesia” loss of feeling /sensation in areas you’d feel when sitting on a saddle
- bladder and bowel incontinence , constipation , etc
- prognosis is poor for complete recovery, some possible
23
Q
SPINAL SHOCK
A
- not a true shock a la neurogenic , septic etc
- occurs in about half of all SCI
- occurs immediately after SCI , within a few minutes to hours
- even undamaged nerves lose function for a bit
- loss of nervous system functioning due to swelling
decreases reflexes below level of injury
loss of sensation
flaccid paralysis below level of injury
24
Q
SPINAL SHOCK TREATMENT/ MANAGMENT
A
- lasts between a week up to several months
- difficult to assess degree of permanent or chronic injury/loss of function during this time
- want to avoid exacerbating injury
- immobilize spine be careful moving
- steroids to reduce swelling - typically methylprednisolone titrated to pt weight
25
Q
PROGRESSION OF SCI
A
-primary or initial injury- disrupts or severs nerve connection in one of the ways mentioned before
- secondary injury - progressive damage which occurs after initial injury
- swelling , edema, clotting, phagocytosis, all maylead to impaired perfusion to nerve cells loss of function
- repair
- scar tissue formation- cannot conduct nerve signals
26
Q
EFFECTS OF SCI
A
- generally speaking, all body systems and their functions will be inhibited in some form below the level injury
- paraplegia /tetrapalegic
27
Q
CIRCULATORY
A
- injury above T5 , inhibits sympathetic nervous system influence
- prone to bradycardia
- peripheral vasodilation - hypotension
- autonomic dysreflexia
28
Q
CIRCULATORY CARE
A
- TED/ SCD
- anticoagulant therapy
- cardiac monitoring
- fluids
- change position slowly for orthostatic hypotension
29
Q
AUTONOMIC DYSREFLEXIA
A
- stimulus below level of injury
- nerve impulses cannot reach brain to signal
- autonomic aspect of peripheral nervous system responds to stimulus
peripheral vasoconstriction = life threatening increased BP - signs - sudden, increased BP, bradycardia, anxiety, headache, bronchospasm, seizures,chills
skin flush/ sweating ABOVE, goosebumps BELOW
30
Q
TREATMENT AUTONOMIC DYSREFLEXIA
A
- remove stimulus- full bladder / bowel most common , pain, pressure ulcer, tight clothing , burns
- empty bowel /bladder, check foley, loosen clothing, reposition
- lower BP- nifedepine,topical nitrates, hydralazine IV
- notify MD
- Check BP frequently
- untreated - potential seizure, stroke MI, death
31
Q
RESPIRATORY/AIRWAY
A
- loss of respiratory muscle tone/ function
- difficulty expectorating
- may cause diaphragmatic breathing
- hypoventilation
- pulmonary edema
- above C4 total loss of respiratory muscle use
mechanical ventilation required to stay alive
32
Q
RESPIRATORY CARE
A
- vent if needed
- suction
- pulse ox
- blood gases
- Quad cough- press abdomen inward during cough helps clear secretions
- pulmonary toilet- bronchodilation , mucolytics, chest physiotherapy, breathing excercises, IS all to clear secreatons from airway
33
Q
BOWEL/ BLADDER
A
- incontinence
- loss of urge
- constipation
- urinary stasis - UTI, kidney stones
- autonomic dysflexia
- reflexic (T12 and up ) keeps reflex but spastic bladder- small uncontrolled voids
- Areflexic (T12 and down) flaccid bladder, no voluntary voiding , overflow incontinence
34
Q
BOWEL/BLADDER CARE
A
- toilet frequently / bowel and bladder training
- intermittent cath
- foley / rectal tube
- surgery - cystostomy
- anticholenergics - reduce contractions (Detrol)
35
Q
GI
A
- decreased GI motility
- monitor electrolytes if gastric suctioning present
- pt may need swallow studies
- high calorie, protein , and bulk diet
36
Q
NEUROLOGICAL
A
- neuro checks
- poor thermoregulation
- pain- psychotropic meds : neurotin is very common
- Neurontin - anticonvulsant, treats nerve pain as well, monitor pt mood, motor coordination, eye movement
37
Q
MOBILITY
A
- paralysis
- proprioception
- pain, touch, pressure
38
Q
MOBLITY CARE
A
- immobilization of neck
- orthostatic hypotension
- pt/rehab/ot
- toilet frequently
- monitor for skin breakdown
- ROM passive/ active
39
Q
PSYCHOSOCIAL
A
- high level cervical may impede ablility to speck
- anxiety / depression related to prognosis /lifestyle changes
- disengagement from aspects of care they can manage or complete
40
Q
EMERGENCY MANAGEMENT
A
- maintain airway
- prevent further injury (secondary damage)
- prevent spinal shock
41
Q
INITIAL MANAGEMENT
A
- airway stays a priority
- O2 per nasal cannula
- intubation - 1/3 will need intubation, especially cervical injuries
- immobilize neck- rigid collar, spine board, log roll to turn, maintain neutral position
42
Q
CARE IN HOSPITAL
A
- MRI, CT scan , X ray
- neuro checks
- foley
- methylprednisolone drip
- hazards of immobility : DVT management , pressure ulcers, continence/incontinence, atelectatsis
