Spinal Cord Injury Flashcards
What sections are the vertebral column composed of and how many vertebrae in each?
- cervical (7)
- thoracic (12)
- lumbar (5)
- sacral (5 - fused in adults)
- coccygeal (4 - fused in adults)
Total of 33
What causes most spinal cord injuries (SCIs)?
Most are trauma-related injuries. Those most common ones are motor vehicle crashed, falls, and then acts of violence and sports/recreation activities.
What are the classifications of spinal cord injuries?
- complete spinal cord injury (loss of all voluntery motor and sensory function below the level of injury) - caused by damage to the entire level of the spinal cord
- incomplete spinal cord injury - preservation of some sensory or motor function below the level of injury because of partial damage to the spinal cord)
What kind of injury causes paraplegia?
Injury to the thoracolumbar region (T1 - L1) that causes loss of motor and sensory function of the lower extremities
What kind of injury causes tetraplegia (also referred to as quadriplegia)?
Result of injury to the cervical regions (C1 - C7)
Damage to upper motor neuron pathways results in what type of muscle and reflex affect?
Produces hypertonia, spastic paralysis, persistent muscle spasms, abd exaggerated tendon reflexes
Damage to the lower motor neurons produces what kind of affect?
Flaccid paralysis, characterized by weakness, loss of motor tone, and no reflexes
Why are complete spinal cord injuries to C1 and C2 often fatal?
Because the patient is unable to breathe spontaneously
What is the primal injury to the spinal cord?
Occurs when excessive force is applied to the cord; it is neurologic damage that occurs at the moment of impact
What causes primary injury to the spinal cord?
- violent motions of the head and trunk
- fracture and dislocation of the vertebral column
- blunt or penetrating trauma
What are four different mechanisms of injury in SCIs?
- hyperflexion
- hyperextension
- flexion-rotation
- blunt or penetrating trauma
What typically causes a hyperextension injury and what is the associated pathophysiology?
- Caused by a forward and backward motion of the head by sudden acceleration
- Rear end collisions and falls where the chin is pushed up (think whiplash as a mild form)
- Causes posterior compression and anterior ligament may stretch or tear
What typically causes a hyperflexion injury and what is the associated pathophysiology?
- Most often caused by a sudden deceleration of the motion of the head
- Causes can be a head on collision or diving accident
- The head and cervical spine continue forward while the thorax stops
- Ruptured or torn posterior ligaments result
What typically causes a compression/axial-loading injury and what is the associated pathophysiology?
Caused by a vertical force along the spinal cord that fractures vertebral bodies and sends bony fragments into the cord
Typically occurs with diving into shallow water or jumping from tall heights and landing on the feet or buttocks
What is a distraction injury and what causes it?
Occurs when the vertebrae and spinal cord are stretched excessively, pulling the structures apart, as in hanging.
What is secondary injury r/t SCI?
Refers to the multifaceted pathological mechanisms that start after the primary SCI that can last from days to weeks. These can include edema, bleeding, and ischemic injury to the cord.
What typically causes a rotation SCI injury and what is the associated pathophysiology?
- Caused by lateral flexion or twisting of head and neck
- Causes tear or rupture of posterior ligaments, dislocation or facet joints, and fractures at articular processes
- T-bone MVAs and falls, as well as sports injuries
What are two pathophysiological proceses that contribute to secondary injury?
- intraparenchymal hemorrhage and ischemia
- inflammatory processes
What are some interventions that decrease secondary injury?
Immobilization & stabilization
Airway management
Adequate physiological support
Methylprednisolone
What diagnostic tools are used for SCI?
X-ray
Computed Tomography (CT) Scan
Magnetic Resonance Imaging (MRI)
Angiograph
Somatosensory-evoked potentials (SEPs)
What is included in the assessment for SCI?
Physical Assessment:
- Includes assessment of motor, sensory, and reflex function
- serial neurological exams hourly for first 24 hours
- Monitored closely for respiratory failure
Assessing for shock states:
Spinal shock
Neurogenic shock
What is the most importat data to collect in the sensory examination?
The exact point on the patient where normal sensation is present. Sensory assessment moves from lower to upper body regions because it is easier for the patient to recognize the onset of a sensory stimuus that the cessation of a stimulus.
How is sensation tested?
Sensation is tested along dermatomes.
True or false: Autonomic dysfunction is more extensive when the level of injury is higher.
True
What two forms of shock may develop following severe cord trauma?
spinal shock and neurogenic shock
What is spinal shock?
- Occurs within 30 to 60 minutes after injury
- Manifested by the absence of all reflect activity, flaccidity, and loss of sensation below the level of the injury
- Syndrome usually subsides within 24 hours but may last 7 to 20 days post injury
- Treatment is symptomatic
In what patients does neurogenic shock occur in?
Patients with an injury above T6
What is neurogenic shock?
- Often classified as a form of hypovolemic shock secondary to a relatively hypovolemic state caused by massive vasodilation and peripheral pooling of blood
- Patho centres on the loss of sympathetic control from the brainstem and higher centres, which allows the parasympathetic output to go unchecked
- Patient experiences hypotension, bradycardia, decreased cardiac output, and hypothermia with the loss of the ability to sweat below the level of the lesion
WHat is the main clinical manifestation of of neurogenic shock?
- arterial hypotension
- bradycardia
- warm, flushed skin
What is involved in the management of SCI?
Surgical stabilization
Manual stabilization
Steroid therapy
Respiratory therapy
What are some complications of SCI?
Altered mobility
Pulmonary dysfunction
CNS dysfunction: Autonomic dysreflexia
Abnormal perfusion
Abnormal reflex activity
Ineffective temperature regulation
Malnutrition
What is priapism?
Persistent penile erection; may be present in males. Occur at moment of injury and resoles spontaneously.
What does the presence of perineal reflexes indicate?
That bowel and bladder training may be feasible
What does the presence of the anal wink and bulbocavernosus reflexes indicate?
That the injury is an UMN injury and will determine the type of bowel training.
What is involves in manual stabilization of an SCI?
- skull tongs
- halo device
- braces
What are important aspects of care for a patient wearing a halo vest?
- Tape a halo vest wrench on the front of the vest in case CPR is required
- Inspect pins and traction bars for loose pins
- Do not pull the vest struts to move or position the patient
- Assess motor function and sensation every 2 to 4 hours
- Perform pin care per unit protocol and monitor pin sites for signs of infections
- Turn every 2 hours, inspect skin around vest edges
- Provide skin care
What is the most common cause of morbidity and mortality in acute SCI?
respiratory complication
