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N304 > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

What is tetraplegia (also known as quadriplegia)?

A

partial or complete loss of use of all four limbs

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2
Q

What is paraplegia?

A

partial or complete loss of use of the lower extremities

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3
Q

What is pentaplegia?

A

also called respiratory quadriplegia (quadriplegia plus impairment or loss of respiratory muscles)

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4
Q

What are the two ways one can look at a level of vertebral injury? Explain the difference between the two.

A

SKELETAL:
vertebral level where vertebral bones and ligament dmg is most extensive

NEUROLOGICAL:
lowest segment of the spinal cord where bilateral sensory and motor function are normal

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5
Q

What region of the spine can injury cause dmg to the phrenic nerve?

A

C3-C5

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6
Q

What level can cause dmg to the nerves of the upper limbs?

A

C5-T1

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7
Q

What region can affect the sympathetic nervous system?

A

T1-L4

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8
Q

Above which level can tetraplegia occur?

A

C8

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9
Q

Below which level does paraplegia usually occur?

A

T1

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10
Q

What are the four mechanisms of SCI?

A

1) COMPRESSION; crush vertebrae and force fragments into spinal canal
2) ROTATION; tearing of ligaments that support the spine
3) HYPEREXTENSION; ruptures anterior ligaments
4) FLEXION; ruptures posterior ligaments

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11
Q

What are the 5 types of spinal cord injuries?

A

1) Cord CONCUSSION
2) Cord CONTUSION
3) Cord COMPRESSION
4) LACERATION
5) TRANSECTION
6) HEMORRHAGE

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12
Q

Describe a cord concussion

A

results in temporary disruption of cord mediated functions

short duration

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13
Q

Describe a cord contusion

A

bruising of neural tissue causing swelling and temporary loss of cord mediated function

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14
Q

Describe what a cord compression injury is.

A

it is pressure on the cord causing ISCHEMIA to the tissues.

Requires decompression to prevent permanent damage

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15
Q

Describe what a transection spinal cord injury is.

A

It is severing of the spinal cord resulting in permanent loss of function

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16
Q

Describe what a hemorrhage spinal cord injury is.

A

Bleeding into the neural tissue due to blood vessel damage.

Usually no major loss of function

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17
Q

What ASIA grade is associated with a complete spinal injury?

A

Grade A

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18
Q

What ASIA grades are associated with an incomplete spinal injury?

A

Grades B-D

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19
Q

What is a complete spinal injury?

A

when you have COMPLETE loss of SENSORY and MOTOR function below level of injury

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20
Q

What is an incomplete spinal injury?

A

MIXED loss of motor and sensory function

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21
Q

What is the degree of loss dependent on in an incomplete spinal cord injury?

A

Level of injury and specific nerve tracts damaged

22
Q

What are the two levels of motor neuron injury one can have?

A

Upper and Lower injury

23
Q

How does upper motor neuron injury present?

A

As SPASTICITY as the reflex arc is untouched and complete its circuit

in this situation the motor neurons are unable to temper the responses and spasticity is seen (over control by reflexes with no regulation from upper)

24
Q

How does lower motor neuron injury present?

A

As FLACCIDITY as the reflex arc is broken before it contacts the spinal cord

25
Q

What are the two phases of spinal cord injury?

A

Primary phase

Secondary phase

26
Q

Describe the primary phase of spinal cord injury.

A

Physical disruption of axons

Maximal deficit is observed immediately

Neurologic injury that occurs at the time of initial trauma or mechanical injury

27
Q

Describe the secondary phase of spinal cord injury

A

Ischemia, electrolyte imbalance (d/t things that alter cell membranes) and inflammatory responses

begins immediately, may extend days

Mechanical re-injury

Release of endogenous substances at the injury site

28
Q

At what point is prognosis best determined at?

A

72 hrs post injury

29
Q

What are the two types of shock that can occur in SCI?

A

SPINAL shock

NEUROGENIC shock

30
Q

What amount of people with SCI experience spinal shock?

A

50 percent

31
Q

Describe what SPINAL shock is

A

it occurs immediately after the injury

it is complete, temporary loss of motor, sensory, reflex and autonomic function, and visceral sensation

32
Q

How long does SPINAL shock last?

A

about 48 hrs, but can last weeks

as it resolves, person will regain some of the functions

33
Q

What is usually the cause of SPINAL shock?

A

disruption of communication of the spinal sympathetic nerves

34
Q

Describe what NEUROGENIC shock is

A

The temporary loss/disruption of autonomic function below level of injury

Occurs soon after the injury

Has a triad of symptoms

35
Q

What levels of injuries can NEUROGENIC shock occur with?

A

with cervical or upper thoracic injuries

above T6

36
Q

How long does NEUROGENIC shock last?

A

about 3 days, but up to 3 weeks

37
Q

What are the triad symptoms associated with NEUROGENIC shock?

A

Bradycardia, hypotension, and inability to regulate temperature

can have dilated peripheral vessels leading too decrease return and CO

38
Q

What are the characteristics of SPINAL shock below the level of injury?

A

decreased reflexes
loss of sensation
flaccid paralysis

39
Q

What is the priority of care in the prehospital phase?

A

Communication with EMS

40
Q

If the injury is above C4, what will the patient likely need?

A

mechanical ventilation

41
Q

What are the 5 phases of care for SCI?

A

1) prehospital resuscitation
2) ER resuscitation (primary survey/resuscitation, secondary survey)
3) Definitive/operative care
4) Critical care
5) Rehabilitation

42
Q

What are some priorities in the critical care phase?

A

Need to monitor breathing, effort, secretions, O2

May have vagal suppression which could cause cardiac arrest when moved

inc r/o dvt (anticoag and SCD)

dec venous return

may need meds for bp

monitor for bleeding

be aware signs may be masked

Monitor GI

Fluid and electrolyte

swallowing, tube feed may be necessary

urinary retention

overdistended bladders (can lead to renal failure, uti)

careful repositioning (sensory dec)

may need PPI to prevent ulcers

43
Q

What are the two types of Definitive care?

A

Surgical and Non surgical

44
Q

What are some common surgical interventions?

A

laminectomy with fusion

Harrington rods

spinal fusion

45
Q

What are some non surgical interventions in definitive care?

A

Cervical traction (ie halo)

Immobilization of the neck in neutral position (ex halo vest)

Brace tongs

46
Q

When can autonomic dysreflexia occur?

A

at any time after resolution of spinal shock

47
Q

What is autonomic dysreflexia?

A

an acute episode of exaggerated sympathetic response to a noxious stimuli (usually a distended bladder or constipation) below the level of injury

48
Q

Why does autonomic dysreflexia occur?

A

it is a result of a lack of control from the higher brain centers

49
Q

What level of injuries is autonomic dysreflexia associated with?

A

Associated with innuries t6 or higher

lower ones usually have enough sympathetic outflow to control visceral reflexes

50
Q

What are the signs and symptoms of autonomic dysreflexia?

A

Severe hypertension, bradycardia, severe headache, nasal stuffiness, and flushing

51
Q

What should you do if autonomic dysreflexia is detected?

A

Have it treated immediately to prevent hypertensive stroke

usually treated with rapid acting antihypertensives immediately

52
Q

What is the usual cause of neurogenic shock?

A

inability to control vascular smooth muscle

N304 (4 decks)

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