Spinal Cord Injury Flashcards
What is a spinal cord injury?
major trauma to the vertebrae of the spine that causes nerve damage and prevents impulse transmission in the body.
severity is based on the sensory and motor loss associated with the injury.
What are the 5 segments of the spine?
- cervical (7)
- thoracic (12)
- lumbar (5)
- sacral (5)
- coccyx (4)
What do the cervical nerves control?
- head, neck
- diaphragm, upper limbs.
- motor movement and sensory
What do the thoracic nerves control?
- chest, abdominal and back muscles
What do the lumbar nerves control?
- lower abdomen, back and lower limbs
What do the sacral nerves control?
- bowels, bladder, buttocks, genitalia.
- lower limbs
What do the coccyx nerves control?
- sensation of the skin on the lower back
What is a primary injury?
What is a secondary injury?
Primary: sudden forceful injury thats distorts the spinal cord and causes damage.
Secondary: damage that occurs to the spinal cord as a result of neuro inflammatory responses.
What happens to the spine with each of these?
- Hyperflexion
- Hyperextension
- Compression
- Rotational
- Transection
- Forward bending
- Backward bending
- force/pressure
- twisting
- seperation
Who is at highest risk for spinal cord injury?
- men
- above age 40 increases risk
- toddlers and the elderly
- any person who participates in risky behaviors; motorcycles, ATV, diving, or sports without proper protection.
What does the level of injury mean?
describes the vertical location of the injury along the vertebral column. (a specific area of the spinal cord/nerves that are damaged.)
- level of injury depends on the extent and type.
- ALL SYSTEMS BELOW THE LEVEL OF INJURY WILL BE AFFECTED.
What are the emergency signs and symptoms?
- pain/pressure in the neck or back
- lack of sensation
- lack of bowel/bladder control
- impaired breathing
- old neck/back positioning
What is spinal shock?
When does it occur?
a reversible loss of neurological functioning following an acute spinal cord injury. (reflex, motor, and sensory function) Occurs after injury and lasts from hours to weeks.
Spinal Shock: Signs, Symptoms & Treatment?
S/S:
- hypotension
- flaccid paralysis
- urinary retention
- fecal incontinence
- sweating
- headache
- increased HR
Treatment:
- minimize stress
- inflammatory medications
- PT/OT
- maintaining healthy weights
Complete vs Incomplete SCI
Complete; is a total loss of all sensory and motor function.
- IRREVERSIBLE
Incomplete; partial loss of sensory and motor function below the level of injury.
- better chance of recovery.
What is a spinal concussion? What are the symptoms?
a mild injury or disturbance to the spine that causes varying degrees of sensory and motor impairment.
- back pain/pressure
- loss of bowel/urinary control
- weakness, lack of coordination
- numbness or tingling
What is brown sequard syndrome?
Incomplete cord injury.
Hemiplegia - meaning one side of the body.
defined by the loss of motor function, movement and balance on the side of injury and a loss of sensory function, pain and temperature on the opposite side of the body/injury.
What is autonomic dysreflexia?
an abrupt onset of excessively high blood pressure due to an overactive autonomic nervous system. (vasoconstriction)
- triggered by irritation or pain to the body, full bladder or bowel.
What is the symptoms of autonomic dysreflexia?
S/S:
- flushing, sweating
- pounding headache
- bradycardia
- sudden HTN
- vision changes
- goosebumps
- seizures
What is the treatment for autonomic dysreflexia?
Treatment is focused on fixing the problem that triggered it!
- postion changes
- treating for pain
- assess the body for anything putting pressure on it
- emptying the bladder and bowel
- removing tight clothing
What are the mobility considerations for a patient with a SCI ?
- ADLs; eating, showering
- repositioning, Q2 turns
- range of motion
- PT/OT
- SCD/stockings
- ORTHOSTATIC HTN
Coping & Emotional changes; how do we address the patient and their family ?
assist the patient/family through their loss and grief, encourage them to verbalize their feelings and concerns.
- encourage family participation.
- acceptance of the diagnosis leads to the best quality of life.
What situations require emergency care? and what are the first two things you do ?
- unconscious
- head injuries
- MVA
- Falls
- penetrating injury
- ABC’s!! Maintain the airway!! check the airway and ensure the patient is breathing.
- Immobilize! stabilize the spine
What are the pharmacological interventions?
- antibiotics for infection
- pain/nerve pain management
- anticoagulants for DVT prevention
- steroids for inflammation
Considerations for cervical traction:
do not move or change the free hanging weights
if it becomes dislodged immediately stabilize the spine and call the HCP.
Considerations for the Halo device:
never lift or grab the patient by the fixator
always keep the wrench with the patient
only clean the pins with normal saline and then apply antibiotic ointment.
if dislodge immediately immobilize the head/neck with rolled towns and call HCP.
