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Medpsych: Test 4 > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

what is the fx of the vertebrae?

A

provide bony support while still allowing mobility

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2
Q

what makes up the gray matter of the spinal cord?

A

Anterior horns- motor relay pathways

Posterior horns- sensory relay pathways

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3
Q

what makes up the white matter of the spinal cord?

A

Corticospinal tract: voluntary motor
Spinothalamic tract: pain sensation
Posterior columns: touch sensation

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4
Q

what can cause injury to spinal cord?

A

issues with blood supply to cord

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5
Q

why is it important to differentiate where in the sacral region injury occurred?

A

it determines bladder, bowel and sexual function/dysfunction

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6
Q

what does Injury to UMN destroy?

A

destroys cerebral influences or control over LMN (called UMNL- upper motor neuron lesion)

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7
Q

what does Injury to UMN result in?

A

spasticity (spastic paralysis)- loss of coordinated and integrated cerebral control over all reflex activity below level of injury

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8
Q

What does injury to LMN result in?

A

flaccid paralysis- destruction of the reflex arc breaks connection to intact UMN

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9
Q

what is the average age for SCI?

A

16-30

19 most freq

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10
Q

what does life expectancy depend on?

A 
age at injury (and/or how long ago they were injured)
Other complications (secondary issues)
Severity of injury
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11
Q

what is the term for 4 limbs paralyzed? 2 limbs?

A

Tetraplegia

paraplegia

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12
Q

what are the causes for traumatic SCI?

A

MVA- most frequent- 37%
Falls
Violence
Sports injuries (most diving)

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13
Q

how does cancer cause a non traumatic SCI?

A

tumor within cord or in spinal canal pressing on cord

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14
Q

how does blood supply cause a non traumatic SCI?

A

Bleed from vessel into canal which takes up space + compresses spinal cord –> no blood supply
Occlusion of blood flow into cord i.e. due to blood clot or crush injury

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15
Q

what is a simple fracture of the vertebral column?

A

usually neural arch without injury to the spinal cord

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16
Q

what is a Compression or Wedge Fracture?

A

anterior compression injury to the vertebral body

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17
Q

what is a Comminuted or Burst Fracture?

A

shattering injury to the vertebral body;

fragments impinge on spinal cord; result in severe damage

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18
Q

what is a Teardrop Fracture?

A

small fragment chipped from vertebra;
lodges in spinal canal
associated with posterior dislocation of vertebral body

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19
Q

what is Dislocation/subluxation

of the vertebral column?

A

Vertebral bodies become displaced and can cause traction

Subluxation = partial dislocation

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20
Q

what is a Fracture/dislocation

of the vertebral column?

A

Describes a fracture and dislocation often associated with ligamentous and cord injury

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21
Q

what is the extent of a spinal cord injury based on?

A

Amount of force (how hard did injury take place)
Direction of force
Rate of application of the force

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22
Q

what is a flexion injury of the spine?

A

Forward bending that exceeds normal bending

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23
Q

what is the point of impact for a flexion injury?

A

Back of head

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24
Q

what is hyperflexion?

A

whiplash

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25
Q

what is the point of impact for an extension injury?

A

chin or face

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26
Q

what can cause a compression injury?

A

Spinal loading from blow to top of head or landing hard on your feet

when vertebrae are weakened by conditions like osteoporosis and cancer with bone metastasis

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27
Q

what level of the spinal cord does compression injury occur?

A

cervical level or thoracolumbar area

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28
Q

what is a axial-rotation injury?

A

Twisting tears fibers of spinal cord

causing very unstable injury

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29
Q

at what level of the spinal cord does axial rotation injury occur?

A

lumbosacral joint and at C1-C2 joint

Stability of sacrum with lots of movement on top

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30
Q

what can cause a penetrating injury?

A

gunshot, stab

burst or teardrop fracture where bone lodges itself in cord tissue

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31
Q

what can penetrating injury result in?

A

cord injury without vertebra (bone) injury and vice versa

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32
Q

what is a coupling injury?

A

multiple mechanisms for injury such as compression or traction with flexion/extension
(more mechanisms = more complication)

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33
Q

what occurs during a primary injury?

A

occurs at the time of the mechanical injury

small hemorrhage in gray matter followed by edema in white matter causing necrosis

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34
Q

what types of injury do primary injury involve?

A

compression, stretch, shear, and contusion

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35
Q

what does laceration cause?

A

primary injury to the cord with associated bleeding and edema

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36
Q

what is secondary injury?

A

increase the spread of injury, pathology that occurs following injury

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37
Q

what does secondary injury cause?

A

vascular- vessel trauma and hemorrhage; can lead to ischemia and edema

neural- loss of spinal reflexes below level of injury resulting in spinal shock, vaso spasm and further inhibit blood flow, increasing necrosis

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38
Q

how do you prevent further damage in secondary injury?

A

Anti-inflammatory medication

Open up space in vertebral canal so swelling has room to occur

39
Q

what is an unstable injury?

A

when vertebral and ligamentous structure not able to support or protect injured area

Stability needs to be provided in order to heal

40
Q

what determines a stable injury?

A

alignment and strength is maintained

No soft tissue damage and musculoskeletal system is intact

41
Q

what is tetraplegia?

A

impairment or loss of motor and/or sensory function in the cervical segments of the cord due to damage of neural elements within the spinal canal

42
Q

what does tetraplegia result in?

A

impairment of function in arms trunk, legs and pelvic organs (4 limbs)

43
Q

what does tetraplegia not include?

A

peripheral nerve injuries

44
Q

what is paraplegia?

A

impairment or loss of motor and/or sensory fx in thoracic, lumbar, or sacral (NOT Cervical) segments of spinal cord

45
Q

what injured parts of spinal cord does paraplegia include? what does it not include?

A

conus medullaris and cauda equina injuries at tip of spinal cord

NOT peripheral nerves outside the spinal canal

46
Q

what is complete SCI?

A

complete loss of all motor and sensory nerve transmission to areas below level of injury

47
Q

what are the causes of complete SCI?

A

complete severance of cord
complete breakage of nerve fibers by stretching of the cord (coverings could be intact and cord may look normal)
complete ischemia of cord by interruption of total blood supply
Can have incomplete injury with lacerations not complete

48
Q

what is incomplete SCI?

A

partial laceration or necrosis of spinal cord

Some info can get back and forth

49
Q

What does the neurological assessment of SCI examine?

A

movement, sensation and reflex activity

50
Q

what does the diagnosis of the neurological assessment describe?

A

level of vertebral fracture and extent of neurological deficit, to the last normal fxing segment of spinal cord

51
Q

what does MMT detect?

A

changes in neurologic fx. gives info re: complete v. incomplete injury and level of injury

52
Q

what do the sensory assessments detect?

A

changes in neurologic fx.

sensation organized in dermatomes that correspond with spinal nerves

53
Q

what do the reflex assessments detect?

A

differentiation of upper motor neuron lesion and lower motor neuron lesion

54
Q

what does the radiographic assessment document?

A

level of injury

55
Q

what does the radiographic assessment provide info for?

A

info for level of stability of injury

56
Q

what info does radiographic assessment not provide?

A

may not capture extent of bony displacement at moment of injury if the vertebrae has returned to normal alignment

57
Q

what does the radiographic assessment demonstrate?

A

bone and soft tissue injury

alignment

58
Q

what does CAT scan do?

A

outlines spine and perispinal structures clearly

59
Q

what does MRI do>?

A

direct imaging of soft tissues, ie the cord, ligaments and intervertebral discs

60
Q

what is emergency care of SCI?

A

stabilization for transport

breathing- ventilator support may be needed

61
Q

what is post emergency care of SCI?

A

primary goal following ABC’s: decompress the spinal cord by realignment of the spinal canal
closed reduction through skeletal traction
surgical reduction with internal skeletal stability

62
Q

what is spinal shock?

A

interruption of sympathetic nervous system

63
Q

what is neurogenic shock?

A

body’s reaction to sudden interruption of central nervous system control

64
Q

what are symptoms of spinal shock?

A

hypotension
bradycardia
hypothermia

65
Q

what is hypotension?

A

low blood pressure, caused by passive vasodilation of the systemic vascular network below level of injury,
decreased circulating blood volume and decreased cardiac output

66
Q

what is bradycardia?

A

slow pulse

67
Q

what is hypothermia?

A

body’s instability secondary to lack of vasomotor control hampers body’s ability to conserve body heat

68
Q

why does spinal shock occur?

A

Body’s effort to stay alive after injury

69
Q

what is cervical surgery?

A

internal surgery
decompress spinal canal by removing all bony and soft tissue elements pressing against spinal cord
obtain immediate stability for patient movement- via posterior approach using wires and bone grafts

70
Q

how are wires and bone grafts used?

A

wiring of spinous processes
graft using bone from iliac crest, fibula or tibia
plates and screws

71
Q

what is Thoracolumbar surgery?

A

internal stabilization technique using rods and/or fusion; sometimes screws and plates

72
Q

when is a harrington rod used/

A

when stability needed after spinal cord injury after fall or trauma

73
Q

when are bigger rods used?

A

scoliosis

74
Q

when is fusion surgery used?

A

for stability

75
Q

what are methods of external stabilization?

A

immobilization bed

Cervical Traction/Support

76
Q

what are the tools used in cervical traction?

A

Tongs (attached to skull used to figure out what to do) or calipers

Halo- rigid brace used later, after cervical traction with tongs

77
Q

what kind of maintenance is needed for cervical traction?

A

maintenance of pin sites, traction

78
Q

what are contraindications of a halo?

A

severe respiratory problems, chest injuries and burns on trunk or abdomen

79
Q

what are examples of external cervical supports?

A

Semi-rigid cervical orthosis

Cervical collar: more rigid

80
Q

what are examples of Thoracic and Lumbar Traction/Support?

A

Traction

Thorocolumbar orthosis

81
Q

what is autonomic dysreflexia?

A

sudden severe headache secondary to an uncontrolled elevation in BP

82
Q

what is autonomic dysreflexia caused by?

A

stimuli creating exaggerated response of the sympathetic nervous system

i.e. Over-distended bladder, bowel impaction, urinary infection

83
Q

when does autonomic dyreflexia occur?

A

mainly when T 4-6 or higher injury

84
Q

how do you tx autonomic dysreflexia?

A

remove the aversive stimuli

85
Q

what is Orthostatic or postural Hypotension?

A

Dramatic fall in BP when upright posture is assumed due to Disturbed vasomotor control with decreased blood supply returning to heart

86
Q

when does orthostatic hypotension occur?

A

injury T4-6 or higher, with increased incidence at higher levels.

87
Q

what is Deep Vein Thrombosis?

A

Development of a blood clot in the venous structures that Can lodge in heart, lungs, brain causing death

88
Q

how do you tx deep vein thrombosis?

A

Clot meds, surgery

89
Q

how do you prevent another deep vein thrombosis?

A

compression garments

90
Q

What is heterotropic ossification?

A

bone grows where it shouldnt causing signs of localized inflammation or pain, elevated skin temp, etc.

91
Q

where does heterotropic ossification usually occur?

A

major joint i.e. hip, knees, shoulders, elbows

92
Q

where does heterotropic ossification occur in spinal cord?

A

below level of injury

93
Q

how do you tx heterotropic ossification?

A

meds, radiation, operative resection (still risk recurrence), needs to run its course or surgery

Medpsych: Test 4 (8 decks)

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