Spinal Cord Injury Flashcards
Primary injury
Initial mechanical disruption of axon due to a stretch or laceration
Secondary injury
Ongoing, progressive damage
Initial injury
Hemorrhagic areas in center appear within 1 hr, 4 hrs = infarction Hypoxia, decrease in oxygen tension Vasoactive substances released By 24 hr permanent damage due to edema Extent/prognosis determined after
Spinal shock
Temporary neuro syndrome
- loss of reflexes and sensation, flaccid paralysis below level of injury
- important to reverse as quickly as possible
- permanent damage can occur if spinal cord is compressed for 12-24 hr
Neurogenic shock
Loss of vasomotor tone caused by injury
- hypotension and Bradycardia
- loss of sympathetic nervous system innervation
- T6 or higher
Classification
By mechanism of
- injury
- skeletal level
- neuro level
- completeness or degree
Flexion rotation injury
Most unstable
- ligamentous structures
- results in severe neuro deficits
Neuro level
Lowest segment of spinal cord with normal sensory and motor function on both sides of body
Paralysis in relation to vertebrae
Tetra/quadplegia: cervixal
Paraplegia: thoracic and lumbar
Cervical
Controls diaphragm, chest wall, arms and shoulders
Thoracic
Controls upper body, GI function
Lumbar
Controls lower body, bladder, and bowel
Degree of spinal cord involvement
- complete: total loss of sensory and motor function below level of lesion (injury)
- incomplete (partial): mixed loss of voluntary motor activity and sensation
Degree of loss depends on level of lesion and nerve tracts damaged
Central cord syndrome
Damage to central spinal cord
- occurs most commonly in cervical
- motor weakness and sensory loss are present in both upper and lower extremities
Anterior cord syndrome
Damage to anterior spinal artery
- compromised blood flow
- often a flexion injury
Brown-Sequard Syndrome
Damage to one half of spinal cord
- loss of motor function and position and vibration sense
- vasomotor paralysis: on same side as lesion
- opposite side has loss of pain and temperature sensation below lesion
Posterior cord syndrome
Compression or damage to posterior spinal artery
- rare
- usually dorsal columns are damages
- loss of proprioception
Conus Medullaris and Cauda Equina Syndrome
Damage to lowest portion of spinal cord (conus) and sacral nerve roots (cauda equina)
Flaccid paralysis of lower limbs and areflexic (flaccid) bladder and bowel
AISA scale
A: complete, no motor function in S4-S5
B: incomplete: sensory but not motor function below neuro level
C: incomplete: motor function below neuro level and more than half muscles have muscle grade less than 3
D: incomplete: motor function below neuro, at least half have muscle grade 3 or more
E: normal
Immobilization
Cervical -Halo fixation: most common -Skeletal traction -Cervical fusion Thoracic or Lumbar -thoracolumbar orthosis (body jacket)
Respiratory manifestations
During first 48 hr, distress may occur
- above C4: labored breathing/ABGs detoriate, trach or mechanical vent
- below C4: diaphragmatic breathing, hypoventilation
- patient cannot cough effectively
- neurogenic pulmonary edema pharmacy may occur
- physical assessment should concentrate on respiratory for C3-5 injuries
Cardio manifestations
Bradycardia: turn and suction
Hypotension
Hypovolemia
Give IV fluids or vasopressin drugs for BP
Autonomic dysreflexia
Massive uncompensated cardio reaction mediated by sympathetic nervous system
- precipitating factor: distended bladder or rectum
- triggered by sustained stimuli T-6 or below: tight clothing, pressure areas
- HTN (300 SBP), blurred vision, throbbing headache, diaphoresis above lesion, bradycardia
Peripheral vascular problems
PE is the leading cause of death
- DVT during first 3 months
- usual signs of pain and tenderness will not be present
- Doppler exam, TEDS/SCDs (remove every 8 hrs for skin care
- prophylactic heparin or LMWH (enoxaparin)
