Spinal Cord Injury

Question 1

Glasgow Coma Scale (GCS) - what do ratings mean?

Answer 1

• highest score = 15

* the lower the score, the lower the neurologic function

Question 2

what are the effects of a hyperflexion of the head/neck

Answer 2

(head down/diving accidents)

• compression
• dislocation
• instability
• hemorrhage
• edema
• necrosis

Question 3

what are the effects of HYPEREXTENSION of the head/neck

Answer 3

(struck from behind are accident/fall w/chin first)

• vertebrae may fracture or subluxate
• SC stretched and distorted
• contusion
• ischemia of SC

Question 4

what are the effects of AXIAL LOADING/VERTICAL COMPRESSION?

Answer 4

(vertical force along SC - landing on feet, buttocks or head)

• vertebrae shatter (wedge or burst fractures)
• bone fragments damage SC

Question 5

what is the highest priority for a C3-C5 injury?

Answer 5

• respiratory compromise

- b/c cervical spinal nerves (C3-C5) innervate the phrenic nerve ==> controls the diaphragm

Question 6

indicators of significant blood loss?

Answer 6

hypotension ( ↓ BP)
⇡ HR (tachycardia)
weak, thready pulse

Question 7

Anterior Cord Syndrome

Answer 7

• incomplete SCI syndrome
  Cause: flexion and dislocation of cervical cord
  Intact function: deep touch, position, vibration
  Treatment: surgery
  Loss of function: pain, temp, light touch, motor function;
  + Babinski’s reflex; spastic paralysis

Question 8

Brown-Sequard Syndrome

Answer 8

Cause: hemi-section of cord
Intact function:
* ipsilateral - light touch, pain, temperature
* contralateral - motor, vibration, deep touch, proprioception
Treatment: immobilization (surgery)
Loss of function
* ipsilateral - motor, vibration, proprioception, deep touch
* contralateral - pain temp, light touch

Question 9

Central Cord Syndrome

Answer 9

Cause: hyperextension or lesion of SC
Intact function - sensory function in varying degrees; some pts DO NOT have loss of lower extremity motor function
Treatment: immobilization
Loss of function: upper extremity function w/less significant loss of lower extremity motor function

Question 10

Posterior Cord Syndrome

Answer 10

Cause: hyperextension of C-spine; degeneration of vertebrae and disks –> compression of spinal cord
Intact Function: pain, temp, motor function
Treatment: surgery
Loss of function: proprioception, light touch, vibration
*may be left w/weakness (not all paralyzed)

Question 11

what is spinal shock (aka spinal shock syndrome)

Answer 11

• occurs immediately; cord’s response to injury
• complete, but temporary loss of motor, sensory, reflex and autonomic function
• last < 48 hrs, but sometimes for several weeks
• can’t classify SCI until it resolves

Question 12

what is significance of phrenic nerve?

where does it originate?

Answer 12

• innervates diaphragm

* C3-C5

Question 13

what are manifestations of spinal shock?

Answer 13

• flaccid skeletal muscle paralysis
• absent DTR, sensation and proprioception
• anhydrosis (no sweating) below level of injury
• urinary and fecal retention
• ↓ BP
• ↓ HR

Question 14

treatment of spinal shock

Answer 14

IV fluids (be careful of pulm edema
dopamine - (for ↓ BP)
atropine - brady HR

Question 15

which reflexes returns first in spinal shock?

Answer 15

• sacral reflexes return first
• Bulbocavernosus reflex - light tugging on foley – should elicit rectal contraction
• Anocutaneous relex - stroking skin around anus – visible reflexive contraction of external anal sphincter

Question 16

what is Neurogenic Shock?

Answer 16

• disruption in communication pathways between upper motor and lower motor neurons
• no sympathetic outflow – parasympathetic is unopposed

Question 17

how is Neurogenic Shock treated?

Answer 17

Treat symptoms:
= ↓ BP -- dopamine (inotropic = ⇡ force of contraction)
= ↓ HR -- atropine
= fluids
= vasopressors (to ⇡ BP)

Question 18

What is Autonomic Dysreflexia?

Answer 18

• usually SCI above T6
• uninhibited sympathetic NS response to noxious stimuli
• neurological emergency!

Question 19

What are the manifestations of Neurogenic Shock?

Answer 19

= postural hypotension
= ↓ BP
= ↓ HR
= ↓ cardiac output
= loss of temperature regulation (warm, dry, skin)

Question 20

What are manifestations of Autonomic Dysreflexia?

Answer 20

• ⇡ BP (SBP = 240-300)
• ↓ HR
• sudden, severe HA
• sweating
• flushed skin (above level of SCI)
• pallor (below level of SCI)
• Nausea
• nasal stuffiness

Question 21

Treatment for Autonomic Dysreflexia?

Answer 21

• sit pt up to ↓ BP (60-90 degrees)
• notify provider
• determine cause
  
  • distended bladder (kinked catheter, urinary calculi)
  • fecal impaction
  • cold stress or drafts on lower body
  • tight clothing
  • undiagnosed injury or illness (kidney infection or stone, lower extrem fracture)
• administer hypertensives: clonidine, nitrates, hydralazine

Question 22

Rapid neuro assessment

Answer 22

1. alertness
2. orientation
3. movement of arms and legs
4. pupil size and reaction to light

• Glasgow Coma Scale (score 3-15)
• Respond to painful stimuli? -
• supraorbital pressure
• trapezius muscle squeeze
• mandibular (jaw) pressure
• sternal rub (don’t use as much)