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Patho 3 (Path 312) > Spinal Cord Injury (Mod 1) > Flashcards

Spinal Cord Injury (Mod 1) Flashcards

1
Q

Where do we typically see respiratory issues in relation to spinal cord injuries?

A

T6 and above = ability to cough and inhale are impeded (diaphragm and such are deeply affected)

  • C345 keep the diaphragm alive.
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2
Q

How many spinal nerves are there?

A

31 nerve pairs; one on each side of vertebral column

  • Mix of motor, sensory, and autonomic function
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3
Q

What are the affected systems by autonomic dysfunction from spinal nerve injury

A
  1. High lesions (above T6) result in reduction of sympathetic nervous system activity and vagus nerve stimulation
  2. Cardiac - Hypertension, arrythmias and brady most common (pacemaker)
  3. Respiratory - Bronchial reactivity (atrovent, ventolin)
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4
Q

What is motor and sensory functions influenced by?
- don’t worry about as much.

A

Local site of injury and level of recovery

  • monitored by Asia scale throughout recovery
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5
Q

What is traumatic spinal injury?

A

Impact to the spine that fractures, dislocated, or compresses 1 or more of the vertebrae

  • most common, spectrum
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6
Q

What is non traumatic spinal injury?

A

May be caused by inflammation, cancer, infection, disc degeneration

  • If patients are palliative, are they treating it, important to understand individual care plan
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7
Q

What are the 3 different categories of spinal injury?

A
  1. High C Spine (C1-C2)
  2. Mid-Low C spine (C3-C8)
  3. T spine Injury
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8
Q

What are the implications of a High C spine injury

A

High C spine injury pts would be vent dependant for the rest of their life

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9
Q

Mid low c spine injury complications?

A

May need cough assist and volume recruitment with their lives

  • includes assisted night ventilation
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10
Q

T spine injury implications?

A
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11
Q

Be aware of and look at slide 9; but it won’t be tested specifically.

  • good idea to look at though
  • add to slides and just look at it
A
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12
Q

Incomplete or complete spinal injury?

A
  1. Incomplete = preservation of sensory of motor function below level of injury
  2. Complete = Absence of sensory and motor function below level of injury
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13
Q

What are 4 types of Vertebral Fractures?

  • SLide 11 - Describe later in separate cards
A
  1. Compression
  2. Burst
  3. Flexion/Distraction
  4. Dislocated
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14
Q

Signs and Symptoms of a Spinal Injury

A
  • Suspected mechanism of injury (fall, trauma)
  • Pain/Pressure in neck or back
  • Weakness or paralysis (can be immediate or take time as swelling occurs)
  • Numbness, tingling, loss of sensation
  • Loss of bladder/bowel control
  • Respiratory Failure (abdominal paradox if diaphragm impaired)
  • Hypotension, Bradycardia
  • Loss of bulbocavernous reflex (Indicative of Spinal Shock)
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15
Q

Review slide 13 later

A
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16
Q

When does Neurogenic shock occur when a spinal injury occurs?

A

SCI above T6

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17
Q

What are the implications of Neurogenic shock that results from spinal cord injuries?

A

Loss of sympathetic tone and vasodilation

  • Hypotension, bradycardia, bronchoreactivity
  • Lost of ability to sweat below level of injury
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18
Q

What are treatment options for neurogenic shock that results from spinal injury?

A

Supportive until injury is diagnosed and treated

  • Fluid and inotropes to maintain MAP
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19
Q

What are weaning considerations for a Pt that suffers a spinal injury?

A

Dependant on recovery, level, and severity of injury

  • VC > 15 ml/kg for extubation
  • Weaning is often slow and cautious in these situations
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20
Q

What are decannulation considerations for a pt with a tracheostomy that suffers a spinal injury?

A
  1. Swallowing
  2. Effectiveness of cough
  3. Tracheal Stent
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21
Q

What complications are associated with allowing a cuff leak for pts that are permently ventilated?

A

Loss in delivered volumes

  • Speech therapy
  • Communication
  • Infection risk
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22
Q

Initial respiratory management for spinal injuries?

A
  1. Mechanical ventialtion
  2. Tracheostomy
  3. Non invasive ventilation
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23
Q

When would non invasive ventilation be considered for spinal injuries

A

For low c spine injuries with higher lung volumes (long term options)

  • Pts may suffer from OSA
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24
Q

What does of Maintenance of Lung Volumes involve for patients with chronic injury during the acute phase?

A

Reducing VC by 20-60% depending on level of injury/progress

  • Lung volumes are variable over recovery
  • Vital capacity monitoring (SVC)
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25
Q

What does of Maintenance of Lung Volumes involve for patients with chronic injury?

A

Interventions often done in conjunction w/physical therapy and assisting cough.

  • Intermittent manual breathing
  • Breath stacking (MLVRM = one way valve bagger)
  • MIE
  • Glossopharyngeal breathing
  • Abdominal Binding
  • Like the acute phase; we still want to reduce VC
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26
Q

What secondary layer of therapy can breath stacking with a MLVRM provide?

A

Secretion clearance (cough assist)

  • may require pt education w/fam later down the line
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27
Q

What are the risks of MLVRM (breath stacking) and how do you mitigate the risk?

A

Risk of pneumothorax because of the one way valve

  • mitigate risk by corredinatin with the pt
  • Ensure that cuff is down if one is present (can be done up but risk is high)
28
Q

Should the cuff be inflated or deflated for a MIE?

A

Inflated?

29
Q

What is MIE?

A
30
Q

How is the ability to produce a Cough affected by spinal injury (generally)?

A

Ability to produce effective cough is decreased due to loss of innervation to abdominal and inner intercostal muscles

  • other muscles could be recruited to compensate depending on the level of injury
  • Both a large insp and exp effort are needed for an effective cough
31
Q

How is effective cough assessed?

A

Peak Cough Flow

  • Normal > 360-400 L/Min
32
Q

What is normal Peak Cough Flow

A

Normal > 360-400 L/Min

33
Q

What could affect with Peak cough flow results?

A

Tracheostomy tube

34
Q

What could help produce a large insp and exp effort for a effective cough

A
  1. Pt compliance
  2. MIE
  3. MLVRM and Abdominal/manually assisted cough
35
Q

What are the risks of a ineffective cough or poor bronchopulmonary hygiene?

A

Pneumonia

  • Ineffective cough, poor lung volumes, poor swallow, and need for trach put SCI pts at increased risk
  • Increased risk of resp failure due to pneumonia when VC < 200ml
  • Quick action on therapy would antibiotics and humidity.(make it a slide on its own)
36
Q

Add slides 19-21 forward

A
37
Q

Anatomy of the spine columns (segments)

  • i.e cevical?
A
  • Cervical (7)
  • Thoracic (12)
  • Lumbar (5)
  • Sacral (5 + fused)
  • Coccygeal (4 + fused)
38
Q

Acute Spinal cord injury managment?

A

Usually involves stabilization, confirmation of injury, and neuroprotection which involves:

  • C spine collars/braces
  • CT/MRI
  • Shock management
  • Surgical stabilization/removal of foreign objects.
  • Neuroprotection (Hypothermia via prednisone)
39
Q

What kind of shock is usually associated with SCI?

A

Neurogenic/distributive shock

40
Q

What complications are associated with spinal shock (neurogenic)?

A

Loss of sympathetic tone and vasodilation

  • loss of ability to sweat below level of injury
  • Hypotension, bradycardia, bronchoreactivity
41
Q

Treatments for spinal shock (neurogenic)?

A

Supportive until injury is diagnosed and treated by:

  • Fluids and inotropes to maintain MAP
42
Q

Weaning management plan for SCI?

A

The usual, but VC needs to be > 15 for extubation

  • some cases need permeant trachs

-NIV is a long term option post extubation for low C spine injuries with higher lung volumes

43
Q

Quick action plan for pneumonia for SCI patients?

A

Antibiotics and humidity.

  • patients can’t clear secretions and at higher risk of resp failure due to pneumonia when VC < 200ml
44
Q

How is VC affected by SCI?

A

Reduction of VC by 20-60% depending on level of injury/progress during recovery.

45
Q

Why are interventions such as MIE, breath stacking, or physio important to managing SCI patients?

A

SCI patients can’t maintain lung volumes due to diaphragm weakness…or cough

  • untreated issues could lead to derecruitment of lung volumes or atelectasis (chest wall rigidity)
46
Q

When is pulmonary embolism at the highest risk of developing?

A

3 months after injury, but increased risk remains after 3 months (poorly documented)

47
Q

Treatment options for pulmonary embolism associated with SCI?

A

A bunch of just in case therapies aka prophylactics

  • Prophylactic anticoagulant therapy
  • Prophylactic IVC filter
48
Q

Why is Abdominal Cough Assist contraindicated for SCI with pulmonary embolism

A

Increase in intrathoracic pressure can potentially dislodge or worsen a pulmonary embolism by forcing the embolus further into the pulmonary circulation, leading to more severe obstruction of blood flow in the lungs.

49
Q

Hemodynamic risks associated with pulmonary embolism?

A

pulmonary embolism are at risk of hemodynamic instability due to compromised blood flow to the lungs; could affect systemic blood pressure and cardiac function

50
Q

Why is pulmonary edema at risk of developing for acute SCI patients?

A

Excessive fluid admin to treat hypotension due to neurogenic shock

51
Q

Therapies to prevent atelectasis if SCI causes reduced lung volumes?

A

Lung volume maintaince therapy: MLVRM, IPPB, MIE

52
Q

C1-C2 injury Impact on breathing

A

Severe requiring mechanical ventilation

  • Diaphragm is completely paralyzed (Phrenic nerve C345)
  • Loss of all resp muscle function
53
Q

C3-C5 injury impact on breathing

A

Severely weakens or ceases diaphragm function

  • may require ventilatory support
  • night time support
  • Risk of resp infections due to inability to clear secretions effectively
54
Q

C6-C8 injury impact on breathing

A

Don’t typically affect the diaphragm, breathing is not significantly impaired.

  • Diaphragm is still fully functional
  • Accessory resp muscles may be weakened = weak cough and/or weak deep breathing
55
Q

Ventilator dependent C Spine injury?

A

C1-C3

56
Q

Possible ventilation or NIV dependent C spine injury?

A

C3-C4

57
Q

C spine injury independent respirations

A

Possible paralysis of abdomen and impaired coughing but generally:

  • C5
  • C6-8
58
Q

Full normal respiratory spinal cord injury location?

A

T12 and lower

  • Injuries in the T1-T11 region may weaken the diagram or accessory respiratory muscles at varying degrees but still be able to retain breathing
59
Q

Sign and symptoms of spinal cord injury (SCI)

A

Suspected mechanisms
pain pressure in back

  • weakness or paralysis
  • numbness loss of sensation
    loss of bowel control
  • respiratory failure
  • Hypotension, bradycardia
60
Q

What is spinal shock

A

Flaccidity of muscles and loss of reflexes (hyporeflexia)

  • may have altered body temp, skin color changes, no sweating, hypotension
61
Q

What is a Compression injury?

A

Vertebral body compressed anteriorly result of fall or osteoarthritis

62
Q

Whats a Burst Injury

A

vertebrae crushed by extreme forces. Body fragments can cause additional injury such as in a Car accident

63
Q

Whats a Flexion/Distraction

A

Injury involves posterior and middle spinal columns

  • Severe whiplash
64
Q

Whats a dislocated injury?

A

Any type of injury with a moved vertebrae

  • very unstable
  • may cause cord injury or severing.
65
Q
A

Patho 3 (Path 312) (10 decks)

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