Spinal Cord Injury Flashcards
Most Common causes for Spinal Cord Injury
Motor vehicle accidents
Falls
Violence (predominantly gun shot wounds)
Sports related injurie
Risk factors:
Younger age
Male gender (78% of population with spinal cord injury)
Alcohol/drug use
Spinal Cord Injury Pathophysiology
Transient concussion: client fully recovers
Contusion, laceration, compression of spinal cord tissue (alone or in combination)
Complete transection (severing of the spinal cord)
Vertebrae most commonly affect: C5, C6, & C7, T12, and L1
These vertebrae are more susceptible to injury due to the greater range of mobility
Types of Injuries:
Transient concussion
Contusion (bruising)
Laceration (deep cut)
Compression (pressure placed on cord)
Complete transection (severing of cord)
Spinal Cord Injury: Primary and Secondary
Primary Injury:
Result of initial trauma or injury, usually permanent
Secondary Injury: Result of edema and hemorrhage
Major concern for critical care nurses
Early treatment needed to prevent long-term damage or permanent damage
Clinical Manifestations- Depends on the type and level of the injury
Complete Spinal Cord leisons: Loss of both sensory and voluntary motor communication from brain to periphery
Results in paraplegia or tetraplegia
Incomplete spinal cord leison:
Ability of the spinal cord to relay messages to/from the brain is NOT completely absent
Sensory and/or motor fibers are preserved below the injury
Effects of Spinal Cord Injuries:
Central Cord Syndrome
Anterior Cord Syndrome
Lateral Cord Syndrome (Brown-Sequard Syndrome
Central Cord Syndrome
Characteristics:
motor deficits
Sensory loss more pronounced in the upper extremities
bowel/bladder dysfunction is variable
Or can be completely preserved
Cause:
Injury or edema to the central cord (typically cervical area)…hyperextension
Anterior Cord Syndrome
Characteristics:
Loss of pain, temperature, and motor function below the level of the lesion
Light touch, position, and vibration sensation remain intact
Cause:
Acute disc herniation or hyperflexion injuries with fracture/dislocation of vertebra.
Injury to the spinal artery
Lateral Cord Syndrome: Brown Sequard Syndrome
Characteristics:
Ipsilateral paralysis or paresis with ipsilateral loss of touch, pressure and vibration
Contralateral loss of pain and temperature
Cause:
Transverse hemisection of the cord (half of the cord is transected from north to south)
Knife or missile injury (GSW, shrapnel)
Fracture/dislocation of unilateral articular process
Acute ruptured disc
Assessments and Diagnostics
Full neuro exam with frequent neuro checks
Full head to toe exam
Diagnostics:
Lateral cervical spine x-rays
CT Scan
MRI (if further injury suspected)
If MRI is contraindicated, a myelogram may be used
Continuous ECG monitoring
Bradycardia and asystole are common in acute spinal cord injuries
Emergency Management
ALL the following clients must be ruled out for spinal cord injury:
MVC
Diving or contact sports injury
Fall
Direct trauma to head/neck
ANY OF THESE INJURIES … YOU MUST ASSUME THERE IS A SCI UNTIL IT IS RULED OUT
Emergency Management Cont:
At the Scene:
Immobilization of head/neck must occur
Focus upon maintaining head/neck in neutral position
to prevent flexion, rotation, or extension
Use hands, back board, or cervical immobilizing device-including head blocks working together
Client must be lifted in one movement with all team members
Trauma Center:
Referral to a regional spinal injury or trauma center
Many changes occur within the first 24 hours
It is important to have multiple disciplines working with patient
Medical Management
Respiratory therapy:
O2 to maintain paO2
Intubation may be required
In high cervical spine injuries, phrenic nerve is damaged (which stimulates the diaphragm)
Intramuscular diaphragmatic pacing is currently in clinical trial phase
Medical Management 2:
Skeletal fracture reduction and traction:
Traction (weights are applied)
Halo device (ring fixed to skull by 4 pins)
Surgical management indicated:
Compression is evident
fragmented/unstable vertebral body
wound that penetrates cord
bony fragments in spinal canal
neuro status is deteriorating
Non-Surgical Treatments
Steroid infusion
Decrease inflammation and swelling
High dose within 24-48hrs
Controversial / only slight benefits
Stabilization with cervical (neck) traction/alignment (see next slide):
Braces
Halo traction
Gardner-Wells Tongs traction
Surgical Treatments
Decompression
Releasing pressure on the spinal cord
Causes: bone, disc, blood clot, tumor
Internal fixation and instrumentation
Placing metal rods, screw, and/or hooks to prevent further injury
Bone grafting for fusion
Spinal Shock
Sudden decrease of reflex activity below level of injury with:
No sensation, paralyzed, flaccid, and reflexes are absent
BP and HR may be decreased
Prolonged hypotension and bradycardia can worsen damage to the spinal cord; therefore, important to keep MAP > 85 mmHg
Bladder and bowel function affected
Paralytic ileus most often occurs within first 2-3 days after SCI and resolves within 3-7 days
Neurogenic Shock
Loss of ANS function below level of lesion
Hypotension, bradycardia, decreased CO, pooling in extremities and peripheral vasodilation
Patient will not perspire in paralyzed portions of the body…watch for s/s fever
Respiratory problems: secretion retention, increased paCO2, decreased paO2, respiratory failure, and pulmonary edema
Other Spinal Cord Complications:
Venous thromboembolism / PE
Respiratory failure / pneumonia
Autonomic dysreflexia
Pressure injuries
Infections
Urinary
Local infection at the pin sites
Nursing Interventions
Promoting adequate breathing and airway clearance
Preventing injury
Maintaining skin integrity
Maintaining urinary elimination
Improving bowel function
Providing comfort measures
DVT/PE anticoagulant therapy/SCDs
Recognizing Autonomic Dysreflexia
Autonomic Dysreflexia
Occurs as a result of exaggerated autonomic responses that have an injury above T6
Occurs after spinal shock is resolved
Triggers:
Distention of bladder/bowels
Stimulation of the skin
Pressure ulcers
infection
Signs/symptoms:
Severe, pounding headache
Profuse diaphoresis above spinal lesion
Nausea
Nasal congestion
Bradycardia
Extreme HTN
Long Term Care for Paraplegia/Tretraplegia Patients
Increasing mobility:
Exercise programs
Mobilization
Preventing disuse syndrome:
ROM, repositioning, proper body alignment
Promoting skin integrity:
Frequent skin assessments and repositioning to decrease risk of pressure ulcers
Improving bladder management:
Encourage 2.5 liters of intake/day
Establishing bowel control:
Bowel training program
Long term Care Continued
Counseling on sexual expression:
Assistance with erectile dysfunction
Enhancing coping mechanisms:
Managing grief and depression
Decreased life expectancy
Risk for:
Autonomic dysreflexia
Bladder/kidney infections
Orthostatic hypotension
VTE
Spasticity
Mental health issues
Pressure ulcers…leading to fistulas, osteomyelitis, and sepsis
