Spinal Cord injury Flashcards
1
Q
traumatic spinal cord injuries
most common in who?
most common cause?
A
- most common in young men
Causes:
- car accidents
- falls
- violence
- sports/recreation injuries
- alcohol
- disease
- work accidents
- risky behavior
- most injuries cause crushing, edema, hemorrhage or infarct
2
Q
what are the most common spinal segments that are injured with spinal cord injuries
A
- C4-C7 and T12-L2
- most mobility and least stability
3
Q
Common MOI for spinal cord injuries
A
- hyperflexion injury
- flexion-rotation injury
- hyperextension injury
- Vertical compression injury
4
Q
hyperflexion injuries
A
- head is pushed forward until chin is forced against chest
- fractures the bones at the front of the neck/back
- stretches/tears the ligaments
- can cause a cervical wedge fracture
- hitting the windshield when being hit from head on
5
Q
Flexion rotation injury
A
- can occur in both cervical and lumbar spine
- rear end collision with passenger rotated toward driver
- the head and body rotate in opposite directions severely twisting the ligaments, bones and spinal cord to the point where they may rupture, fracture or sever
- can cause anterior disolcation
6
Q
Hyperextension injury
A
- result of strong posterior force or falling with chin hitting a stationary object
- the head is forced back further than it can extend, fracturing the bones in the back of the neck and tearing the supporting ligaments in the front
- avulsion fracture can occur and rupture of the anterior longitudinal ligament
7
Q
Vertical compression
A
- the head is forced down into the shoulders with great pressure, compressing the spinal cord and possibly fracturing bones in the neck
8
Q
compression vs burst fracture
A
Compression:
- stable
- failure of anterior column without injury to middle column
Burst:
- unstable
- failure of both anterior and middle column
- often a boney fragment projecting into spinal canal
9
Q
Acute treatment of SCI
A
- stabilization of vital signs (sympathetic/parasympathetic regulation may be off)
- administration of anti-inflammatory drugs to limit swelling - inflammation that causes compression will make it worse
- stabilization/traction of spine
- repair and stabilization of fractures
- fusions, rods, plates
- external stabilization via Halo, SOMI, TLSO, jewitt etc.
10
Q
Halo immobilizer
A
- traction and stabilization
- lock pins into place
- typically used for hyperflexion/hyperextension
11
Q
SOMI
A
- Sterno-occipital-mandibular immobilizer
- can come off
- prevents flexion and rotation
12
Q
Jewitt brace
A
- prevents trunk flexion
13
Q
TLSO
A
- fitted supine
- must roll the patient into this
- goes around torso
14
Q
CASH brace
A
- prevents flexion and extension of T6-L1
15
Q
respiratory management
A
- cervical region
- diaphragmatic breathing
- use of ventilator
- glossopharyngeal breathing (frog breathing where air is forced into lungs)
- maximizing function
16
Q
Skin management for SCI
A
- bed and wheelchair positioning
- patient education
- high risk areas
- treatment of pressure ulcers
17
Q
Autonomic dysfunction with SCI
A
- most frequency in complete SCI above T6
- orthostatic hypotension
- poor thermoregulation
- autonomic dysreflexia
18
Q
autonmoic dysreflexia
A
- sympathetic: normal stimuli that wouldnt normally bother you does
- such as a full bladder
19
Q
Signs & symptoms side effects of autonomic dysreflexia
A
- hypertension: can be life threatening
- sweating above level of lesion
- flushed skin above level of lesion
- nasal congestion
- headaches
- blurry vision or seeing spots
- goose bumps
- only way to fix this is to get rid of stimulus
20
Q
causes of autonomic dysreflexia
A
- noxious or potentially noxious stimuli
- catheter tube kinked
- bladder distension
- UTI
- bowel impaction
- wheelchair or bed positioning causing pressure
21
Q
treatment of autonomic dysreflexia
A
- get patient upright to make orthostatic
- lossen any tight clothing or restrictive devices
- look for cause and correct it
- monitor BP and pulse
- emergency procedures
- contact nursing - catheterization PRN
- do not continue therapy
- pt may need medication to reduce BP - nitro
- monitor BP and symptoms for about 2 hours after episode
22
Q
Spinal shock
A
- occurs shortly after injury - last hours to weeks
- period of areflexia
- loss of sweating
- hypertension => hypotension
- flaccid paralysis below level of lesion
- complete or incomplete injury
- once this period is over there may be a different outcome for patient
23
Q
end of spinal shock period
A
- return of spinal reflexes
- stretch reflexes
- anal reflexes (sphincter function)
- hypertonia and spasticity below level of lesion may begin to develop as well as hyperreflexia
24
Q
Classification of SCI
A
- complete = lack of sensation/motor function at lowest sacral segment (S4-S5)
- incomplete = preservation of some sensation and or motor function including S4-S5
25
SCI neurological level
- can vary for motor function and sensation
- can vary left to right
- can vary for motor function and sensation
- can vary from left to right
- lowest level where both sensory and motor function are normal
- zone of partial preservation
- determined by testing ASIA