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MS3 Exam 3 > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

Anatomy review

A
  • spinal cord runs through the vertebral column with spinal cords extending out, into the body
  • 31 pairs of spinal nerves
  • 33 vertebrae in total
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2
Q

The vertebrae

A

-when talking about SCI we identify the level of injury by the vertebrae

Cervical: C1-C7

Thoracic: T1-T12

Lumbar: L1-L5

Sacrum: (S1-S5)–all 5 are fused

Coccyx: CO1-CO4–all 4 are fused

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3
Q

How many new incidents per year

A

12k

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4
Q

plurability are related to…

A

MVAs

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5
Q

Falls account for…

A

second highest incidence

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6
Q

Biggest at risk groups are…

A

men, young adults 16-30, Caucasians

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7
Q

Most SCIs occur at…

A

C1-5, T12, L1-3

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8
Q

Patho of SCIs

A
  • initial trauma which kills neuron, initiates inflammatory response
  • reduced blood flow due to trauma, swelling, edema
  • compression due to swelling from injury and inflammation
  • WBCs bleeding into spinal cord causing more inflammation. Cytokine release may lead to scar tissue formation
  • early intervention and tx can help limit degree of damage to spinal cord
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9
Q

Etiology of SCIs

A

-excessive force to the spinal column in one of several ways

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10
Q

Hyperflexion

A

bend neck forwards

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11
Q

hyperextension

A

bend neck backwards

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12
Q

compression

A

landing on head or butt

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13
Q

rotational

A

bend neck to side or turn to side

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14
Q

transection

A

partial or complete severance

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15
Q

Grade A ASIA

A
  • complete

- no sensory or motor fx preserved in sacral segments S4-S5

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16
Q

Grade B ASIA

A
  • incomplete

- sensory but not motor fx preserved below the neurologic level and extending through sacral segments S4-S5

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17
Q

Grade C ASIA

A
  • incomplete
  • motor fx preserved below the neurologic level
  • majority of key muscle have a grade less than 3
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18
Q

Grade D ASIA

A
  • incomplete
  • motor fx preserved below the neurologic level
  • majority of key muscles have a grade greater than 3
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19
Q

Grade E

A

normal motor and sensory fx

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20
Q

Complete SCIs

A

-total loss of fx below level of injury

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21
Q

Incomplete SCIs

A

some feeling or movement remains

  • central cord
  • anterior cord
  • posterior cord
  • brown-sequard syndrome
  • conus medullaris syndrome and cauda equina
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22
Q

Central cord damage

A
  • more severe motor loss in UE than LE
  • bladder dysfunction, retention
  • almost all will have some degree of recovery, usually starting in LE
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23
Q

Anterior cord damage

A
  • damage to anterior 2/3rds of cord
  • loss of fx below level of injury
  • loss of pain, temp sensations
  • keep proprioception
  • poor prognosis, some motor recovery may be possible
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24
Q

Posterior cord damage

A
  • very rare, damage to posterior portion of spinal cord
  • most have good motor, pain, and temp control
  • mainly loss of proprioception, light touch
25
Q

Brown-Sequard Syndrome

A
  • hemisection of spinal cord
  • same side (ipsilateral) motor paralysis
  • loss of proprioception below LOI
  • opposite side (contralateral) loss of pain and temp sensation below LOI
  • best prognosis, majority will be able to ambulate independently eventually with tx
26
Q

Conus Medullaris Syndrome and Cauda Equina

A
  • injury to tapered end of spinal cord (L1, rarely L2)
  • not a true SCI, injury to spinal nerves branching from SC
  • partial or complete loss of sensation below LOI, saddle anesthesia, low back pain

bladder and bowel incontinence, constipation, etc

-prognosis is poor for complete recovery, some possible

27
Q

saddle anesthesia

A

loss of feeling/sensation in areas you’d feel when sitting on a saddle

28
Q

Spinal shock

A
  • not a true shock of the neurogenic, septic, etc
  • occurs in about half of all SCI
  • occurs immediately after SCI, within a few mins to hours
  • even undamaged nerves lose fx for a bit
  • loss of nervous system functioning due to decreases reflexes below level of injury, loss of sensation, flaccid paralysis below level of injury
29
Q

Spinal Shock Tx and Management

A
  • lasts between a week up to several months
  • difficult to assess degree of permanent or chronic injury/loss of fx during this time
  • want to avoid exacerbating injury
  • immobilize spine and be careful moving

-steroids to reduce swelling
(typically methylprednisone titrated to pt weight)

30
Q

Primary or initial injury

A

-disrupts or severs nerve connections in one of the ways mentioned before

31
Q

secondary injury

A
  • progressive damage which occurs after initial injury

- swelling, edema, clotting, phagocytosis, etc. all may lead to impaired perfusion to nerve cells, loss of fx

32
Q

scar tissue formation

A

cannot conduct nerve signals

33
Q

Effects of SCI

A
  • generally speaking, all body systems and their fx will be inhibited in some form below the level of injury
  • paraplegia/tetraplegia
34
Q

Circulatory Characteristics to SCI

A
  • injury higher than T5, inhibits SNS influence
  • prone to bradycardia
  • peripheral vasodilation…hypotension
  • autonomic dysreflexia
35
Q

Circulatory Care

A
  • TED/SCD
  • anticoag therapy
  • cardiac monitoring
  • fluids
  • change position slowly for orthostatic hypotension
36
Q

Respiratory Care

A
  • vent if needed
  • suction
  • pulse ox
  • blood gases
  • quad cough
  • pulmonary toilet
37
Q

quad cough

A

press abdomen inward during cough helps clear secretions

38
Q

pulmonary toilet

A
  • bronchodilators
  • mucolytics
  • chest physiotherapy
  • breathing exercises
  • IS
  • all to clear secretions from airway
39
Q

Bowel/Bladder Characteristics

A
  • incontinence
  • loss of urge
  • constipation
  • autonomic dysreflexia
  • urinary stasis–UTIs/kidney stones
40
Q

Reflexic

A

higher than T12

  • keeps reflex but spastic bladder
  • small uncontrolled voids
41
Q

Areflexic

A

lower than T12

  • flaccid bladder
  • no voluntary voiding
  • overflow incontinence
42
Q

Bowel/Bladder Care

A
  • toilet frequently/bowel and bladder training
  • intermittent cath
  • foley/rectal tube
  • sx–cystostomy
  • anticholinergics–reduce contractions (Detrol)
43
Q

GI Characteristics

A
  • decreased GI
  • monitor electrolytes if gastric suctioning present
  • pt may need swallow studies
  • high calorie, protein, and bulk diet
44
Q

Neurological

A
  • neuro checks
  • poor thermoregulation
  • pain–psychotropic meds: Neurontin very common
45
Q

Neurontin

A
  • anticonvulsant
  • txs nerve pain as well
  • monitor pts mood
  • motor coordination
  • eye movement*****!!!!!!
46
Q

Mobility

A
  • paraplegia/quadriplegia/hemiplegia
  • proprioception
  • pain, touch, pressure, etc
47
Q

Mobility Care

A
  • immobilization of neck
  • orthostatic hypotension
  • PT/Rehab/OT
  • toilet frequently
  • monitor for skin breakdown
  • ROM passive/active
48
Q

Psychosocial

A
  • high level cervical may impede ability to speak
  • anxiety/depression related to prognosis/lifestyle changes
  • disengagement from aspects of care they can manage or complete
49
Q

Emergency Management

A
  • maintain airway
  • prevent further injury
  • prevent spinal shock
50
Q

Initial Management

A

-airway stays a priority
(O2 per NC, intubation)

  • 1/3 will need intubation, especially high cervical injuries
  • immobilize neck (rigid collar, spine board, log roll to turn, maintain neutral position, etc.)
51
Q

Care in Hospital

A
  • MRI, CT, Xray
  • neuro checks
  • foley
  • methyprednisone
  • hazards of immobility
52
Q

hazards of immobility

A
  • DVT management
  • pressure ulcers
  • continence/incontinence
  • atelectasis
53
Q

Traction

A

immobilization

  • skeletal traction
  • used to realign or reduce fracture
  • must be maintained at all times
  • do not change amount of weight
  • weights must be free hanging
  • if dislodged, stabilize and call for help
54
Q

Most common for cervical injuries

A

halos

-external fixation

55
Q

Care of Ext Fixators

A
  • do not grab or lift by fixator
  • clean pins around skin using saline + antibiotic cream
  • keep wrench nearby, monitor pin placement
  • if displaced, stabilize head of device with towels
56
Q

Medical Emergency care for SCIs

A
  • maintain airway
  • prevent movement/immobilize site of injury
  • prevent shock
57
Q

Pharmacological Tx for SCIs

A

-generally symptom management with exception of methylprednisone

58
Q

Laminectomy

A

-removes lamina (back part of spinal vertebrae, to decompress spinal cord

59
Q

Vertebral fusion

A

joins vertebrae together

MS3 Exam 3 (6 decks)

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