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Patho/Pharm Exam 3 > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

1
Q

Primary injury

A

Initial mechanical disruption of axon due to a stretch or laceration

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2
Q

Secondary injury

A

Ongoing, progressive damage

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3
Q

Initial injury

A 
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
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4
Q

Spinal shock

A

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
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5
Q

Neurogenic shock

A

Loss of vasomotor tone caused by injury

  • hypotension and Bradycardia
  • loss of sympathetic nervous system innervation
  • T6 or higher
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6
Q

Classification

A

By mechanism of

  • injury
  • skeletal level
  • neuro level
  • completeness or degree
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7
Q

Flexion rotation injury

A

Most unstable

  • ligamentous structures
  • results in severe neuro deficits
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8
Q

Neuro level

A

Lowest segment of spinal cord with normal sensory and motor function on both sides of body

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9
Q

Paralysis in relation to vertebrae

A

Tetra/quadplegia: cervixal

Paraplegia: thoracic and lumbar

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10
Q

Cervical

A

Controls diaphragm, chest wall, arms and shoulders

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11
Q

Thoracic

A

Controls upper body, GI function

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12
Q

Lumbar

A

Controls lower body, bladder, and bowel

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13
Q

Degree of spinal cord involvement

A
  • 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

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14
Q

Central cord syndrome

A

Damage to central spinal cord

  • occurs most commonly in cervical
  • motor weakness and sensory loss are present in both upper and lower extremities
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15
Q

Anterior cord syndrome

A

Damage to anterior spinal artery

  • compromised blood flow
  • often a flexion injury
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16
Q

Brown-Sequard Syndrome

A

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
17
Q

Posterior cord syndrome

A

Compression or damage to posterior spinal artery

  • rare
  • usually dorsal columns are damages
  • loss of proprioception
18
Q

Conus Medullaris and Cauda Equina Syndrome

A

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

19
Q

AISA scale

A

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

20
Q

Immobilization

A 
Cervical 
-Halo fixation: most common
-Skeletal traction
-Cervical fusion
Thoracic or Lumbar
-thoracolumbar orthosis (body jacket)
21
Q

Respiratory manifestations

A

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
22
Q

Cardio manifestations

A

Bradycardia: turn and suction
Hypotension
Hypovolemia
Give IV fluids or vasopressin drugs for BP

23
Q

Autonomic dysreflexia

A

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
24
Q

Peripheral vascular problems

A

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)
25
Q

Urinary system

A

Urinary retention immediately after injury

  • bladder is atonic and distended
  • overdistention can result in reflux to the kidney
  • in dwelling catheter inserted
  • UTI can cause death in SCI
  • neurogenic bladder
26
Q

Neurogenic bladder

A

Dx: urodynamic testing, IV pyelogram, urine culture
T: fluid intake of 1800-2000 ml/day, urine drainage
Surgery: sphincterotomy
Drugs: anticholinergics, alpha adrenergic blockers, antispasmodic

27
Q

GI system

A

Above T5: hypomotility

  • development of paralytic ileus and GI distention (relieved by NG tube)
  • intraabdiminal bleeding
  • indications of bleeding: continued hypotension and decreased Hct and Hg
  • stress ulcers: corticosteroids, H2 receptor blockers
  • T12 or below: areflexic bowel
  • neurogenic bowel
28
Q

Neurogenic bowel

A

Voluntary or involuntary evacuation of bowel may be lost

  • high fiber diet and fluid intake
  • suppositories, stool softeners
29
Q

Thermoregulation

A

Below injury there is no vasoconstriction, piloerection, or heat loss thru perspiration

  • poikilothermism: adjustment of body temp to room temp
  • decreased ability to sweat or shiver
30
Q

Metabolic needs

A

48-72 hrs, GI tract may stop function: insert NG tube

  • NG sun ruining can lead to metabolic alkalosis
  • high protein and calories
  • positive nitrogen diet
31
Q

Acute care

A 
Skeletal traction
Maintenance of HR and BP
Insertion of NG
Intubation (check and ABGs and PFTs first)
O2 by high humidity mask
Catheter, IV fluids
32
Q

Criteria for early surgery

A 
Cord decompression may lead to secondary injury
Evidence of cord compression
Progressive neuro deficit
Compound fracture
Bony fragments
Penetrating wounds of spinal cord

Patho/Pharm Exam 3 (13 decks)

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