Spinal Cord Injuries

Question 1

Primary vs secondary spinal cord injuries

Answer 1

primary: initial injury from laceration or stretching
secondary: injuries that occur approx 72 hr after the initial injury; ischemia, hypoxia, micro hemorrhage, & edema cause more damage

Question 2

Characteristics of spinal shock

Answer 2

decreased reflexes
loss of sensation
flaccid paralysis below site of injury

experienced by 50% of SCI cases; TEMPORARY (lasts days to months)

can mask potential post injury neuro function

Question 3

Characteristics of neurogenic shock

Answer 3

hypotension & bradycardia

loss of sympathetic nervous system innervation causes peripheral vasodilation, venous pooling, & dec CO

Question 4

Degrees of spinal cord injuries

Answer 4

complete injury: total loss of sensory and motor fxn below level of injury

incomplete injury: some sensory and motor fxn still intact

Question 5

What scale is used to classify SCIs

Answer 5

ASIA scale; uses sensory and motor assessment to determine severity of injury

Question 6

Clinical manifestations of SCIs

Answer 6

the higher the injury, the more severe

ABCs are a concern

Question 7

Injuries above C4

Answer 7

require mechanical ventilation

Question 8

Injuries above T6

Answer 8

have sympathetic nervous system and cardiovascular effects

bradycardia, peripheral vasodilation, decreased BP & CO, hypovolemia

Question 9

Injuries above T5

Answer 9

cause hypo motility of GI system

Question 10

Complications of SCIs

Answer 10

skin breakdown, risk for infection, problems with thermoregulation, electrolyte imbalances, weight loss, risk for DVTs, urinary problems

Question 11

Drug therapy for SCIs

Answer 11

steroids (decrease inflammation), dextran (increases blood flow within spinal column to prevent hypotension), atropine (neurogenic shock to increase HR), vasopressors for neurogenic shock

Question 12

Autonomic dysreflexia

Answer 12

occurs if reflexes return after spinal shock is over (won’t see this immediately after an injury)

life threatening, massive uncompensated cardiovascular reaction mediated by sympathetic nervous system

occurs in injuries at T6 or above

Question 13

Causes of autonomic dysreflexia

Answer 13

distended bladder or rectum, belt that is too tight, pinched skin

Question 14

S/S of autonomic dysreflexia

Answer 14

HTN, bradycardia, blurred vision, throbbing HA, diaphoresis, anxiety, nausea

Question 15

Interventions for autonomic dysreflexia

Answer 15

elevate HOB to 45 degrees, send someone to call HCP, find the cause (kinked foley, distended bladder, constipation, skin stimulus)

immediate catheterization!