Spinal Cord Injuries - Collins (incomplete) Flashcards
what is the most common population that presents with SCI
50% of acute injuries involve young patients (16-30)
second peak at age 60+
MEN>females
what are patients with SCI at higher risk of
more likely to die prematurely by 2-5x
what is the most common location of SCI injuries
cervical C5 most common
what is the most common manifestation of SCI
incomplete paraplegia
what are the most common mechanisms of SCI
MVC
falls
sports-related injuries
violence
secondary to compression (contusion)
complete transection rare
what is a complication of SCI
neurologic regulations are worse the higher the level of the injury within the spine
what is a primary injury
the initial mechanical insult
what is a secondary injury
persistent physiologic insult
what is the acute timeline
first 48 hours
cytotoxic, inflammatory, vascular, necrosis, nerve depolarization
what is the subacute timeline
48 hours to 14 days
macrophage infiltration and scar initiation
what is the intermediate timeline
14 days to 6 months
continued scar formation
what is the chronic timeline
6+ months
degeneration of spared components
when is the most important time to worry about hypotension s/p SCI
acute phase - compensation for vascular changes
what are the role of steroids in SCI
steroids are anti-inflammatory and targeting acute phase but not clinically understood
what is the initial treatment for a spine trauma patient
immobilization until cleared
what trumps immoblization
treat life-threatening injuries first
what is assessed in the initial survey for spinal trauma patients
gross motor/sensory deficits
tenderness - especially midline
step-offs
palpable fluid collections/hematoma
bruising or abrasions/wounds
what is assessed later in the ED for spine trauma patients
complete neurological exam including perineal sesation and anal sphincter tone
how are spine trauma patients worked up
if they are “walking/talking” and no pain/distracting injuries - dont need imaging
what is first line imaging for spinal injuries
book answer: AP and Lateral x-rays + odontoid for c-spine
Practice: CT usually entire spine
how are stable fractures typical treated
conservative management usually with brace for immobilization
how are unstable fractures typically treated
ORIF, usually fusion procedure
does the degree of the SCI correlate with the stability of the fracture
NO, not necessarily correlated
what level injury is Neurogenic shock seen most commonly
most often with thoracic level injury
what part of the nervous system is disrupted with Neurogenic shock
Sympathetic NS - inability to maintain vascular tone
what is the treatment of neurogenic shock
fluid resuscitation and vasopressors
what is the resolution timeline of neurogenic shock
24-48 hours
what occurs during neurogenic shock
inability to maintain vascular tone
hypotension with BRADYCARDIA and without vasoconstriction
what are the SCI patterns
complete, incomplete or transient
what is transient SCI
temporary: spinal shock
NOT necessarily neurogenic shock though often co-occurring
spinal cord “stinger”
what is the ASIA scale
american spinal injury association system to classify SCI
what is the ASIA grading scale
Grade A (complete injury) through E (normal)
when is the Bulbocavernossus reflex absent
during Transient SCI
when do Transient SCI resolve
24-72 hours - must be resolved to definitively classify SCI
What is an incomplete SCI
some degree of neurologic function present distal to injury
What is ‘sacral sparing’
voluntary anal sphincter tone, perineal sensation, great toe flexion
BARE MINIMUM
what is seen with greater initial function
better prognosis
what is the timeline of neurologic improvement following a SCI
up to 12-18 months
what are the incomplete SCI patterns
Brown-sequard syndrome
Central Cord syndrome
Anterior cord Syndrome
Posterior Cord Syndrome
Ascending
carry information to the brain - sensory
descending
carry information from the brain to target tissue/organs- motor
what should the SCI patients have for treatment
transfer to specialized SCI injury rehabilitation facility - the earlier the better
shorter overall LOS
lower morbidity and mortality
Extensive PT, assistive technologies/devices
often far away, limited beds and expensive
what are common complications for SCI
Gastritis/illeus - NG tube and H2 blockers
Urinary dysfunction - foley or intermittent caths - risks for UTI
Breathing difficulty - “C3,4,5 Keep the diaphragm alive”
Skin Breakdown - reposition every 2 hours, regular inspections, pad pressure points - decreased sensation and loss of motor function
Vascular complications
what are the concerns with vascular complications s/p SCI
most common cause of morbidity and mortality
worse the higher the injury
arterial hypotension, orthostatic hypotension
autonomic dysreflexia
what is autonomic dysreflexia
rapid increased BP (imbalanced sympathetic SN stimulation)
precipitated by some stimuli below level injury
often bowel and bladder dysfunction
