Spinal cord injuries Flashcards
What is responsible for a majority of Spinal cord injuries (SCI)
Motor vehicle accidents
What demographics are responsible for a majority of SCI
Male, 16-30 year olds
Primary injury
-Injury from the actually event. The immediate injury that is caused by whatever trauma the cord is put through. This results in microscopic hemorrhages and initial dmg
Secondary injury
-Injury that comes to the cord AFTER the initial event. This is resulting from inflammation and swelling that compresses on the cord and spine as well as changes in the activity of cells, and cell death.
-This compression can prevent blood flow to the spine, leading to cell death
in an emergency event after the primary injury has occurred. what is the immediate goal in neurologic care
-Prevent secondary injury
Tetraplegia
-Formerly called quadriplegia
-Paralysis or paresis of all extremities and trunk
-The higher up the spine the greater risk of impaired ventilation due to impairment of the phrenic nerve
What level is there increased risk of impaired ventilation
C4 and above due to interference of the phrenic nerve
Paraplegia
Paralysis of lower extremities (normally)
-Occurs below T1
-Truncal instability if upper thoracic region is involved (If injury is lower the is more function)
Does a fractured vertebrae always cause SCI
No that is not the only cause
Contusion
Bruising of the spinal cord
-Can improve over time
Incomplete lesion
Various motor and sensory loss depending on location and extent of injury
-Can still have feeling at or below the injury depending on the severity
Complete or transectional
-Cord becomes completely severed which comes with loss of voluntary movement and sensation below level of injury
-Connection is severed so no impulse can direct below it
Compression of spinal cord
Any condition that puts pressure on the spinal cord
-Injury
-Tumor
-Infection
-Osteoarthritis
SCI diagnostics (Acute injury)
Blood work:
-Arterial blood gas (Make sure adequate ventelation (ABC))
-CBC : Kidney function
-CMP
-PT/PTT: Bleeding factor
-Xray
-CT: If X ray doesnt look good
-MRI: If CT doesnt look good
Most Vulnerable discs
C5-C7
T1-T2
L1
Central cord syndrome
-To simplify, center of the cord is what becomes dmged, leading to motor deficits in the arms with deficits in the legs as well to a less extent
-Bowel and bladder may be affected
-Caused by injury/ edema to center of cord, usually cervical
Anterior cord syndrome
-Damage to majority of the cord on the anterior half, however the posterior half which is responsible for position, vibration, and touch are left in tact
-Loss of pain temp and motor function below the lesion
-Light touch, position and vibration are intact
Lateral cord syndrome
-To simplify: body is split down middle with the affected side losing vibration, motor, deep touch and position, while the uninjured side loses pain, temp and light touch
-Loss of pain, temp, and light touch on the contralateral side
-Loss of vibration, motor function and deep touch on ipsilateral side
Assessment findings SCI
-Neck or back pain (Lack of pain doesnt mean no SCI however)
-Inability to feel light touch, discriminate between sharp and dull or hot and cold
-Absent deep tendon reflexes in affected area
-Flaccid muscles
-Hypotension, worsening when upright
-Shallow respirations (Depending on level of injury)
-Spinal shock
SCI Goals
-Prevent secondary injury (Monitor for swelling, infection)
-Monitor for deterioration of neurologic function
-Prevent complications
Acute care mgmt of SCI: ABC
-ABC first and foremost
-Resp status is number one priority
-O2 therapy
-Maintain airway, dont flex or extend the neck (prevent further trauma)
-May need mechanical ventilation
-Endotracheal tub/trach
-Really good suctioning
Acute care mgmt of SCI: Identification of potential complications
-Neurogenic shock
-Spinal shock
-Autonomic dysregulation
Acute care mgmt of SCI: Hemodynamic support and pharm therapy
Hemodynamic support: Blood pressure can crash and go into shock, give fluids
Pharm therapy: Corticosteroids, decreasing swelling
SCI complications
-Further paralysis (secondary injury)
-Neurogenic shock
-Spinal shock
-Bradycardia (not enough blood flow, leading to poor o2 status)
-Orthostatic hypotension
-Autonomic dysreflexia
-DVT/PE
-Death (In the case of high injury and they dont receive immediate support)
-Atelectasis
-Pneumonia
-Pressure injury
-Depression
-Loss of sexual function
-Incontinence
-Malnutrition
Spinal shock
-Happens in the IMMEDIATE proceeding after the SCI
-Sudden, total, but TEMPORARY loss of all reflexes and autonomic functions below level of injury
-Does not mean this is their final function
-Can lead to worse injuries if they dont receive fluids to increase BP
-Hypotension and shock can further dmg cord
-Can develop bowel distention and paralytic ileus
-Can Last days to weeks as well
Goal to maintain mean arterial pressure in spinal shock
Greater than 85 mmHg to prevent further dmg to spinal cord
Neurogenic Shock
-Sudden loss of communication within sympathetic nervous system with decreased venous tone (Vasodilation) with PRESERVED parasympathetic function
-This vasodilation causes pooling of blood in the extremities
-This can be life threatening
-Occurs in the first 24 hours of SCI
-Hypotension, with BRADYCARDIA= Decreased CO
-Loss of temp control, risk of fevers
-Risk of VTE, dont massage calfes
-Can last days to weeks
Pt. needs to be on a blood thinner
Autonomic dysreflexia
-Acute life threatening medical emergency
-Occurs after spinal shock resolves
-Exaggerated autonomic response to stimuli with SCI T6 and above
-To simplify the body over, reacts to some stimuli such as a full bladder and completely freaks out
-Causes Severe hypertension
Autonomic Dysreflexia: Symptoms
-Severe Hypertension (Risk of hemorrhagic stroke, retinal hemorrhage, MI, seizures )
-Sudden severe headache, blurred vision
-Diaphoresis- profuse above lesion
-Nausea
-Nasal congestion
Autonomic Dysreflexia: Causes
Distended bladder (Most common)
-UTI
-Constipation/impaction
-Pain
-Skin stimulation: Pressure injury, thermal stimuli, tight clothing
Can be pretty much anything
Autonomic Dysreflexia: Treatment
-Position upright immediately
-Remove cause, and assessment (Bathroom or something like that)
-IV antihypertensive (In hospital setting)
SCI meds mgmt
-Glucocorticoids
-Vasopressors
-Antimuscarinic (Bradycardia)
-Plasma expanders (Increase BP)
-Muscle relaxers
-Pain mgmt (Opioids and non opioids)
-anti-coagulants
-Bowel agents
SCI meds mgmt: Glucocorticoids
Methylprednisolone
SCI meds mgmt: Vasopressors
-Norepinephrine, Dopamine
-Increase BP
SCI meds mgmt: AntiMuscarinic
Atropine
-Brady cardia
SCI meds mgmt: Plasma expanders
Dextran
-Increases BP
SCI meds mgmt: Muscle relaxants
Baclofan, Dantrolene, Valium
-Helps with spasticity
SCI meds mgmt: Anti-colagulants
Heparin, lovenox
SCI meds mgmt: Bowel agents
Enema, miralax
-Help with bowel flow
Nursing interventions SCI
-Monitor Resp and cardiac function (o2, Bp. Hr)
-Monitor temp
-VTE prevention (Heparin, compression)
-Maintain traction (No further injury)
-Maintain body alignment , and change position slowly (Dont twist neck
-Skin care: Turn every 2 hours, monitor for redness, signs of pressure sores, special flow bed
-Check pin sites, incisions for infections
Spastic neurogenic bladder
-Upper motor neuron injury
-Develops after neurogenic shock resolves
-Can urinate but does not know when ,and cannot control need
-Condom catheter for men
-Indwelling catheter for female
Flaccid neurogenic bladder
Lower motor neuron injury
Requires intermediate cauterization: Straight cath periodically to use the bathroom
Neurogenic bowel
-Location of injury does not natter
-Needs stool softeners and bulk forming laxatives
-Stimulated bowel movements daily or every other day
-Suppository
-Digital stimulation (Gloves, lube and a finger)
-Need to avoid a vagal response
Vagal reponse
When you stick a finger up someones butt and they develop sudden bradycardia and syncope as a result
Traction for cervical injury
Skeleton tongs
-Halo device: Bolts in skull and a vest attached to stabilize
Surgery for thoracic or lumbar trauma
TLSO brace
How does Neurogenic shock differ from spinal shock
Neurogenic Shock is associated with bradycardia and decreased CO
-Spinal shock you have flaccidity and absent reflexes
Where would tetraplegia transition to paraplegia
T1 level, the higher the lesion in this area the more likely you are to have truncal instability
Which level do people start to experience autonomic dysreflexia
T6 and Above only
