Spinal Cord Injury Flashcards
What are the classifications of Spinal Cord Injury?
Trauma (accidents) vs Non-Trauma
Complete (loss of all motor and sensory function) vs Incomplete (preservation of some motor or sensory function)
What are the Levels of Injury?
C1-C2 : impacts breathing
C4-C5: Driving accidents
C5-C6: Rapid Deceleration
Thoracic/Lumbar: required heavy force
What are the Mechanism of Injury?
Primary: occurs when excessive forces is applied to the cord
Secondary: Starts after the primary and last days to weeks (edema, bleeding, neuro inflammation)
What are the types of Primary Mechanism of Injury? (4)
Hyperflexion: sudden deceleration of the motion of the head (head on collision)
Hyperextension: forward and backward motion (rear-end, whiplash)
Flexion-Rotation: expressive lateral twisting
Compression: vertical force along the SC that fractures vertebral bodies sending bone fragments into cord (shallow diving)
What are the diagnosis?
Detailed hx of accident, radiographic studies, assess sensory/motor
X-ray (level of injury)
CT Scan (visualization)
MRI (all level of cord, tissues, ligament)
Angio (rule out ischemia, neuro defects)
What are the steps to physical assessment?
- Neuro exams q1hr x 24 hrs
- Monitor for resp failure (ABGs, vital capacity, FEV- amount of air forced from lungs in 1 sec)
- Motor status assessment (strength, ROM, Palpate from contractions)
- Sensory status (dermatomes)
What is Spinal Shock
Within 30-60mins after injury (manifested as absent all reflexes, flaccidity, and loss of sensation below injury)
Last 24hrs or up to 7-20 days
What is Neurogenic Shock?
With injury above T6
FOrm of hypovolemic shock seconadry to relative hypovolemia state (caused by massive dilation and peripheral blood pooling)
Pt exp HTN, decreased HR, decreased temp, no sweating
Treat with Fluids and Vasopressors
How to Stabilize and Manage Injury?
(Surgical and Pharmacological)
Surgical – rods, closed/open reduction
Steroid Therapy – methylprednisone (minimize secondary injury)
What are the different types of Stabilization?
Skull Tongs: reduce fractures
Halo device: flexion, extension, and rotational, align spine
Braces: thoracic and lumbar spine
For Respiratory Complications, what parts of the spinal cord affects respiratory?
C1-C2: mechanical ventilation
C3-C5: varying degrees of diaphragm paralysis
C6 and below: impaired intercostal and abd muscle function
What to do for Respiratory Complications?
Monitor O2 Sats, ETCO2
Interventions:
- Treat pneumonia and aspiration with humidified O2
- Incentive spirometry,
- chest physiotherapy
- turn/position
- Suction
What Heart Complications and the interventions?
Orthostatic hypotension, spinal & neurogenic shock, venous pooling
Interventions:
Atropine (symptomatic decreased HR)
IV fluids, inotropes, vasopressors (CO & tissue perfusion)
MAP 85-90 for first 7 days
Continuous Cardiac Monitoring (above T6)
What are Bowel and Bladder Complications, Interventions?
Bladder: catheter (until spinal shock and fluid resuscitation), d/c catheter after reflexes return and good u/o
Bowel: reflexes if injury above tip of L2
Regulation by suppositories or digitals, bowels required routine
What is Autonomic Dysreflexia?
Life threatening complications in patient with SCI above T6
Can cause cerebral hemorrhage
