Spinal Cord Injury III: Other Complications of SCI

Question 1

What is orthostatic hypotension (with BP measurements included).

Answer 1

Drop in BP when person moves from recumbent to upright. Defined as decrease or 20mmHG in SBP or decrease of 10mmHG of both SBP and DBP with increase of 15bpm in pulse when assuming upright position.

Question 2

What are the 6 main causes of orthostatic hypotension? Which ones are most applicable to SCI?

Answer 2

1. Volume depletion
2. Venous pooling
3. Medications
4. Prolonged immobility
5. Sluggish normal regulatory mechanisms
6. Damage/Disease of nervous system
   4 and 6 most applicable.

Question 3

What are the main treatments for orthostatic hypotension in SCI patients?

Answer 3

Tigh-high anti-embolic stockings and abdominal binder worn early then gradual accommodation to upright position using tilt table or reclining w/c gradually brought more upright.

Question 4

How often must patients be turned in bed to prevent bed sores? Other bed considerations?

Answer 4

Every 2 hours turned. Also, must have decreased shear forces and dry and wrinkle-free sheets.

Question 5

Difference between pressure reduction surfaces and pressure relief surfaces.

Answer 5

Pressure reduction redistributes pressure but does not lower pressure below capillary closing pressure. Pressure relief surfaces lower pressure below capillary closing pressure (may have no turning required.

Question 6

What’s the advantages of using a “low air-loss bed”? air-fluidized bed? “rotating or oscillating support surface beds”? Which of these can be used on a patient with an unstable spine?

Answer 6

low air loss beds have air continually pumped out of small holes, keeps skin dry while redistributing pressure throughout whole body.
Air-fluidized pump air through beads providing constantly changing supporting surfaces. Super heavy and expensive though.
rotating or da other bed rock slowly back and forth redistributing pressure on skin - Can be used on patients with an UNSTABLE spine. Others must have stable spine.

Question 7

What 3 things can one do with positioning to help prevent pressure sores in patients with SCI?

Answer 7

1. pillows where needed
2. sidelying, tip pt. 30° back to relieve trochanteric pressure
3. Keep HOB below 30° of elevation to prevent shearing forces on sacrum.

Question 8

What 6 factors must you consider when choosing an appropriate surface in preventing pressure ulcers?

Answer 8

1. Ulcer present?
2. Pt’s skin tolerance to pressure
3. Turning schedule
4. Moisture present (perspiration, wound drainage)
5. Spine stable
6. Functional considerations

Question 9

Some guidelines to preventing pressure sores while patient is sitting

Answer 9

Make sure w/c fits pt
Repositioning
Keep buttock well back in chair with slight ant. tilt to pelvis and no lateral tilt in pelvis (relieves pressure on sacrum/coccyx and one ichial tub respectively).

Question 10

What type of cushion gives the best pressure relief? the best shear prevention? The best function? least expense?

Answer 10

Pressure relief: Air
Shear: Gel
Function: Foam
Least expense: Foam

Question 11

What are the 3 main techniques for pressure relief in sitting?

Answer 11

1. Sitting pushup
2. Weight Shift
3. Power tilt or recline

Question 12

What is autonomic dysreflexia and what are some symptoms/signs of it?

Answer 12

Excessive reaction of sympathetic system to noxious stimulus.
Signs/Symptoms:
Sudden increase in BP
Bradycardia
Pounding Headache
Flushing and profuse sweating above level of lesion.
Feeling of anxiety
Sometimes NO symptoms

Question 13

What are the causes and pathophysiology of autonomic dysreflexia?

Answer 13

Causes:
Loss of descending inhibition from medullary CV centers or hypersensitivity of sympathetic neurons.
Pathophysiology:
Hypertension results from increased sympathetic outflow, results in peripheral vasoconstriction. Results in bradycardia and vasodilation above level of lesion from baroreceptor stimulation in aortic arch/carotid sinus.

Question 14

Treatment for autonomic dysreflexia

Answer 14

1. Treat as medical emergency (increased BP can KILL).
2. Sit pt. up, loosen clothing
3. Try to find noxious stimulus (catheter tube kink
4. Monitor pt’s BP
5. If cause cannot be removed immediately, they need medical tx (local anesthesia, oral pain meds, anti-hypertensives).

Question 15

What is the number 1 sign of DVT? What are the 4 other signs?

Answer 15

#1: Unilateral swelling in calf or thigh
Others:
Discoloration
Pain in calf
Warmth in area
Positive Homan's

Question 16

Signs/Symptoms of PE?

Answer 16

Sudden chest pain
SOB
Tachycardia
Sweating
Apprehension
Fever
Cough

Question 17

Tx for DVT?

Answer 17

Anticoagulant therapy

OOB activity and LE exercises contraindicated

Question 18

What is heterotopic ossification and what are the most common sites for it? Tx for it?

Answer 18

Growth of bone around a joint where no bone should be, mostly in hips, knees, elbows. Treatment includes ROM exercises, meds to restrict bone growth, and surgery to resect bone if severe loss of range.

Question 19

Where does osteoporosis usually occur in SCI patients? What is the 2 main causes of it in SCI pts?

Answer 19

It usually develops in extremities innervated caudal to lesion, NOT in the spine. It is caused by venous stasis and lack of w/b and muscle action on bone.