Spinal Cord Injuries

Question 1

Neurogenic Shock

Answer 1

• Blood vessels dilate
• Severe cord injury
• Hypoxia
• Unable to clear airway
• Bradycardia
• ALOC
• HOTN

Give fluids

Question 2

Spinal Shock

Answer 2

• Complete yet temporary loss for 48 hr
• Loss of motor, sensory, reflex, autonomic function
• Paralytic ileus within 72 hr

Question 3

L3
L4
L5

Answer 3

Sensation in top of foot & calf

Question 4

T10

Answer 4

Umbilicus

Question 5

C3 & C4

Answer 5

Clavicle sensation

Question 6

C7 & C8

Answer 6

Finger sensation

Question 7

CV Changes of SCI

Answer 7

• Bradycardia
• HOTN
• Hypothermia
• Dysrhythmias
• Decreased resp effort

Do not allow HOTN, assess RR often

Question 8

Autonomic Dysreflexia

S&S

Answer 8

• Bradycardia
• Severe HTN
• Sweaty above level of injury
• Goosebumps above/below
• Flushing above level
• Blurry vision
• Spots in vision
• Pale below lesion
• Apprehensive

Question 9

Autonomic Dysreflexia

Causes

Answer 9

• Full bladder
• Tight clothing
• UTI
• Epididymitis
• Scrotal compression
• Constipated
• Hemorrhoids
• Temperature changes
• Hard or sharp object contact

Question 10

High Thoracic SCI Bowel Changes

Answer 10

Spastic bowel & bladder

Lower thoracic injury = flaccid bladder & bowel

Question 11

Complete SCI Complications

Answer 11

• VTE
• Pressure sores
• Osteoporotic bones
• Osteopenic bones
• Heterotopic ossification

H.O: Bony overgrowth into muscle

Spine CT & MRI to Dx

Question 12

T6 injuries: above or at

Answer 12

Airway risk!

PE risk within 5 days after injury

Report O2 below 95% & assess RR every 2 hr

Question 13

Cough Assist

SCI

Answer 13

• For quadriplegics
• Place hands on upper abdomen
• Fingers interlocked
• Push in & up when they cough

Question 14

Dextran

Answer 14

Plasma expander to prevent HOTN

Question 15

Autonomic Dysreflexia

Immediate interventions

Answer 15

• Sit them up/raise HOB
• BP every 10 mins
• Loosen tight clothing
• Assess bladder distention
• Hypotensive drugs to prevent stroke (Nifedipine, nitrate)
• Assess for pressure sore, impaction, catheter kink (use anesthetics!)

Question 16

Airway emergencies in SCI patient

Answer 16

Use jaw thrust, not head-tilt

Question 17

Halo Traction

Answer 17

• Resume activity as tolerated
• No swimming
• Clean pin sites
• Cut food small
• Observe pins for drainage, redness, loosening

Question 18

SCI protocol meds

Answer 18

PPIs for stress ulcers
Stool softeners

Question 19

Spinal Fusion

Answer 19

Assess VS & neuro qhr

Question 20

Flaccid Bowel & Bladder from Lower Neuron Lesion

Answer 20

• Cath self
• Manual pressure over bladder
• Bowel impaction regularly

Question 21

Aging & SCI

Answer 21

• Arthritis from wheelchair stress on arms
• Meticulous skin care needed
• High fiber diet
• More fluids
• Breast exams often
• Osteoporosis prevention
• Vaccines to prevent respiratory complications (major COD)*

Question 22

SCI Sexuality

Answer 22

• Above T6 = reflex erections
• Prophylactic vasodilator
• Ovulation may stop in women
• Vaginal dryness