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Prodigy Quick Review > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

What is the most effective device for minimizing

cervical motion?

A

Halo-thoracic immobilization devices.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 256.

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2
Q

What is the median age of the patient who suffers a

spinal cord injury?

A

25
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 924.

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3
Q

What is the leading cause of death in patients with

spinal cord injury at the scene of the injury?

A

respiratory failure from muscle weakness and aspiration
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 924.

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4
Q

Fibers from what nerve roots innervate the

diaphragm?

A

C3, C4, C5
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 258.

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5
Q

What is the incidence of cervical spine injury in all

major trauma victims?

A

Between 1.5% and 3% of all major trauma victims have a
cervical spine injury
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 255.

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6
Q

The likelihood of a cervical spine injury is considered

minimal if what five criteria are met?

A

1) No tenderness over the midline cervical spine area, 2) no
focal neurologic deficits, 3) normal sensorium, 4) no intoxication
with drugs or alcohol, and 5) no other painful injury that could
distract from the patient’s evaluation of symptoms.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 255-256.

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7
Q

What are the symptoms of acute spinal cord injury?

A

Below the level of injury, the patient will exhibit flaccid paralysis,
total absence of sensation, and loss of temperature regulation
and spinal cord reflexes.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 255.

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8
Q

What are the symptoms of spinal shock?

A

Decreased blood pressure due to loss of preload (there is
significant dilation of the capacitance vessels). If the injury is at
or above T1-T4, the loss of sympathetic innervation to the heart
can result in bradycardia.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 257-258.

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9
Q

How does the skin of patients with spinal shock

compare to that of patients with hemorrhagic shock?

A

Because spinal shock disrupts the compensatory
vasoconstrictive response, patients with spinal shock will exhibit
warm, pink extremities whereas patients with hemorrhagic
shock will exhibit cool, clammy extremities.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 926

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10
Q

What monitoring techniques should be instituted for

patients with spinal shock?

A

In addition to standard monitors, an arterial line should be
placed to allow for moment-to-moment observation of blood
pressure as well as ease-of-access for arterial blood gas
analysis. A pulmonary artery catheter may also be used to
facilitate management of fluid and drug therapies.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1507

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11
Q

What is autonomic hyperreflexia?

A

Autonomic hyperreflexia may appear after spinal shock has
resolved and represents the return of spinal cord reflexes. It is
a massive sympathetic discharge that occurs in response to a
cutaneous or visceral stimulation below the level of transection.
In normal patients, the sympathetic activity that results from this
stimulation is overridden by inhibitory impulses from higher
central nervous system centers. In the spinal cord injured
patient, the sympathetic outflow is isolated from the inhibitory
feedback loop and the sympathetic discharge is unopposed.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 259.

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12
Q

With what spinal cord injury levels is autonomic

hyperreflexia most common?

A

About 85% of patients with a spinal cord injury above T6 will
exhibit autonomic hyperreflexia, but it is uncommon in patients
with lesions below T10.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 259.

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13
Q

What are the signs of autonomic hyperreflexia?

A

Hypertension, bradycardia, and dysrhythmias.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 927.

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14
Q

What types of stimuli may precipitate autonomic

hyperreflexia?

A

Bladder catheterization, defecation, childbirth, distention of the
bladder or rectum, and cutaneous stimulation.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 927.

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15
Q

What precautions can you take to prevent or treat
autonomic hyperreflexia during the perioperative
period?

A

Don’t allow stimulation from surgical incision or other
manipulation to occur before adequate general or regional
anesthesia has been established. Have immediate access to
short-acting vasodilators such as nitroprusside to treat sudden,
severe hypertension. Monitor the patient closely in the recovery
area as autonomic hyperreflexia may not occur until the effects
of anesthetic drugs wear off.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 259-260.

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16
Q

How can autonomic hyperreflexia be prevented in a
parturient with a chronic spinal cord injury
undergoing childbirth?

A

The use of neuraxial anesthesia has been reported to prevent
autonomic hyperreflexia in response to labor contractions.
Epidural anesthesia is less effective than spinal anesthesia in
this scenario as it can spare sacral segments that can be
involved in autonomic hyperreflexia.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 260.

17
Q

Will topical anesthesia prevent autonomic
hyperreflexia from occurring in patients undergoing
bladder procedures such as cystoscopy? Why or
why not?

A

No. Topical anesthesia does not affect the nerves that detect
bladder distention which can precipitate autonomic
hyperreflexia.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 260.

18
Q

How does the level of the spinal cord injury affect the

patient’s pulmonary status?

A

If the level of injury is above C5 then the patient will likely be
apneic without mechanical ventilation. Lower cervical and
thoracic transections can leave the accessory muscles of
ventilation paralyzed resulting in a decreased ability to ventilate
properly or clear secretions.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 258.

19
Q

What are the gastrointestinal complications

associated with high spinal cord injury?

A

The loss of sympathetic tone can predispose patients to peptic
ulceration, especially when combined with the administration of
corticosteroids. Orogastric or nasogastric tubes are often
employed to decompress the stomach which has the combined
effect of easing restrictions on diaphragmatic movement caused
by gastric distention and reducing the risk for aspiration of
gastric contents.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 926.

20
Q

What are the urinary complications that may arise

from chronic spinal cord injury?

A

Bladder infections become common as the patient is unable to
empty the bladder completely. This may also predispose the
patient to renal stone formation and even progress to renal
failure, a common cause of death in patients with chronic spinal
cord injury.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 258.

21
Q

How do patients with acute and chronic spinal cord

injury respond to succinylcholine?

A

Because of the risk for severe hyperkalemia following the
administration of succinylcholine, especially during the first six
months after the injury, it should be avoided in all patients with
spinal cord injury for the rest of their life. Some practitioners will
utilize succinylcholine during the first 24 hours as upregulation
of extrajunctional receptors probably has not had time to occur
yet.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 259.

22
Q

What are the complications that may arise from
prolonged immobility in a patient with chronic spinal
cord injury?

A

The chronic immobility predisposes the patient to osteoporosis,
atrophy of skeletal muscles, and an increased risk for venous
thrombosis.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 258.

23
Q

Why is it important to closely manage hydration

status in a patient with spinal cord injury?

A

Although they may have difficulty maintaining ventricular filling
pressures due to the loss of venous return from the cord
transection, they are prone to pulmonary edema if overhydration
occurs.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 257.

24
Q

How does chronic pain arise from chronic spinal cord

injury?

A

Nerve root pain often presents at or near the site of the original
injury. Phantom pain may occur in areas of complete
denervation.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 258.

25
Q

How long does spinal shock last?

A

In patients who survive, spinal shock can last 1-3 weeks.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 255.

26
Q

How effective are hard cervical immobilization collars

at restricting movement of the neck?

A

Hard cervical collars only reduce neck motion by about 25%.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 256.

27
Q

What is the recommended technique for limiting
movement of the neck during laryngoscopy when a
cervical injury is suspected?

A

Laryngoscopy should be performed with an assistant who
provides manual in-line stabilization.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 256-257.

28
Q

What is the annual incidence of spinal cord injury?

A

Approximately 10,000 spinal cord injuries occur each year.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 924.

29
Q

How is manual in-line stabilization performed?

A

The person performing manual in-line stabilization rests both
hands on each side of the patient’s face with the tips of the
fingers resting on the mastoid processes. A downward
pressure is applied to keep the head still against the table and
prevent flexion of extension of the neck during laryngoscopy.
Hines RL, Marschall KE. Anesthesia & Co-Existing Diseases.
6th ed. Philadelphia, PA: Elsevier-Saunders; 2012: 256-257.

30
Q

What vertebral body is most commonly injured in

cervical spine fractures?

A

C7
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 925.

31
Q

Is an LMA suitable for the management of a patient
with a suspected cervical spine injury who is apneic
or unconscious and hypoventilating?

A

An LMA or Combitube is suitable for placement by paramedics
for transport, but should be replaced with a definitive
endotracheal airway as soon as possible.
Nagelhout JJ, Plaus KL. Nurse Anesthesia. 5th ed. St. Louis,
MO: Elsevier Saunders Company; 2014: 925.

32
Q

Would the use of a McCoy laryngoscope be
appropriate for securing the airway in a patient
undergoing evaluation for cervical spine injury?
What about a flexible fiberoptic intubation?
Translaryngeal guided intubation?

A

While direct laryngoscopy with a McCoy laryngoscope enables
intubation with minimal neck movement, flexible fiberoptic
intubation and translaryngeal guided (retrograde) intubation
enable the anesthetist to secure the airway with no movement
of the neck which is crucial in patients with cervical spine injury.
Barash PG, Cullen BF, Stoelting RK, Cahalan MK, Stock MC,
Ortega R. Clinical Anesthesia. 7th ed. Philadelphia, PA:
Lippincott Williams and Wilkins; 2013: 1494.

Prodigy Quick Review (186 decks)

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