Spinal Cord Injury Flashcards
Glasgow Coma Scale (GCS) - what do ratings mean?
- highest score = 15
* the lower the score, the lower the neurologic function
what are the effects of a hyperflexion of the head/neck
(head down/diving accidents)
- compression
- dislocation
- instability
- hemorrhage
- edema
- necrosis
what are the effects of HYPEREXTENSION of the head/neck
(struck from behind are accident/fall w/chin first)
- vertebrae may fracture or subluxate
- SC stretched and distorted
- contusion
- ischemia of SC
what are the effects of AXIAL LOADING/VERTICAL COMPRESSION?
(vertical force along SC - landing on feet, buttocks or head)
- vertebrae shatter (wedge or burst fractures)
- bone fragments damage SC
what is the highest priority for a C3-C5 injury?
- respiratory compromise
- b/c cervical spinal nerves (C3-C5) innervate the phrenic nerve ==> controls the diaphragm
indicators of significant blood loss?
hypotension ( ↓ BP)
⇡ HR (tachycardia)
weak, thready pulse
Anterior Cord Syndrome
- 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
Brown-Sequard Syndrome
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
Central Cord Syndrome
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
Posterior Cord Syndrome
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)
what is spinal shock (aka spinal shock syndrome)
- 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
what is significance of phrenic nerve?
where does it originate?
- innervates diaphragm
* C3-C5
what are manifestations of spinal shock?
- flaccid skeletal muscle paralysis
- absent DTR, sensation and proprioception
- anhydrosis (no sweating) below level of injury
- urinary and fecal retention
- ↓ BP
- ↓ HR
treatment of spinal shock
IV fluids (be careful of pulm edema dopamine - (for ↓ BP) atropine - brady HR
which reflexes returns first in spinal shock?
- 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
what is Neurogenic Shock?
- disruption in communication pathways between upper motor and lower motor neurons
- no sympathetic outflow – parasympathetic is unopposed
how is Neurogenic Shock treated?
Treat symptoms: = ↓ BP -- dopamine (inotropic = ⇡ force of contraction) = ↓ HR -- atropine = fluids = vasopressors (to ⇡ BP)
What is Autonomic Dysreflexia?
- usually SCI above T6
- uninhibited sympathetic NS response to noxious stimuli
- neurological emergency!
What are the manifestations of Neurogenic Shock?
= postural hypotension = ↓ BP = ↓ HR = ↓ cardiac output = loss of temperature regulation (warm, dry, skin)
What are manifestations of Autonomic Dysreflexia?
- ⇡ BP (SBP = 240-300)
- ↓ HR
- sudden, severe HA
- sweating
- flushed skin (above level of SCI)
- pallor (below level of SCI)
- Nausea
- nasal stuffiness
Treatment for Autonomic Dysreflexia?
- 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
Rapid neuro assessment
- alertness
- orientation
- movement of arms and legs
- 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)
