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Med Surg 3 > SPINAL CORD INGURY > Flashcards

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
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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

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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
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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
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5
Q

ETIOLOGY

A

-excessive force to the spinal column in one of several ways

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6
Q

HYPERFLEXION

A

bend neck forwards

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7
Q

HYPEREXTENSION

A

bend neck backwards

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8
Q

COMPRESSION

A

landing on head or butt

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9
Q

ROTATIONAL

A

bend neck to side or turn to side

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10
Q

TRANSSECTION

A

partial or complete severance

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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
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12
Q

GRADE A

A

complete no sensory or motor function preserved in sacral segments S4-S5

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13
Q

GRADE B

A

incomplete, sensory but not motor function preserved below the neurologic level and extending through sacral segments S4-S5

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14
Q

GRADE C

A

incomplete, motor function preserved below the neurologic level , majority of key muscle have a grade <3

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15
Q

GRADE D

A

incomplete, motor function preserved below the neurologic level, majority of key muscles have a grade >3

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16
Q

GRADE E

A

normal motor and sensory function

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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

Med Surg 3 (5 decks)

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