Spinal Cord & Peripheral Nerve Problems Flashcards
Mechanism of injury
Flexion injury: most common
-hit steering wheel
Hyperextension:
Hit chin
Compression:
Fall, diving
Primary vs secondary injury
Primary: initial injury
-Cord compression
-Cord ischemia
-Penetrating trauma
Secondary injury: happens after injury
-edema and ischemia
Patho
Injury= edema, ischemia, vasoconstriction
Limited space, edema
Increases ischemia
Extent of injury usually after 72 hours
Patho
RBC and plts
Release:
-norepi
-serotonin
-dopamine
Lead to:
Vasoconstriction
Patho
Breakdown of RBCs
Increased free radical formation
Then
Tissue hypoxia
Patho
Neutrophils
Vasospasm/edema
Then
Decreased spinal cord blood
Complete vs incomplete
Complete:
Total loss of sensory and motor below injury
Incomplete:
Mixed loss of voluntary motor and sensory, some intact
Injury
C4
C6
C4:
Tetraplegia
Results in complete paralysis below the neck
C6:
Partial paralysis of hands and arms
And lower body
Injury
T6
L1
T6:
Paraplegia
Paralysis below the chest
L1:
Paraplegia
Paralysis below the waist
Complication
Spinal shock
Immediate response to injury
Usually c-spine injury
Complete loss of reflex activity below injury
Flaccid paralysis
Loss of sensation
No thermoregulation
Complication
Neurogenic shock
Usually c-spine injury
-Loss of vasomotor tone
-Decreased SNS leads to vasodilation (cant compensate w/ -tachycardia, only shock that does this)
-HOTN
-Brady cardiac
(Support BP/HR)
Diagnostic test
CT: gold standard (locate injury)
MRI
Xray: harder to see amount of damage
Emergency management
Prehospital
A,B,C,D
Patent airway
O2 sat >90%
SBP >90: may need IV fluids, vasoactive meds
IV 2 large bore IV or IO
Emergency management
Acute care
Conyinue what
D
Stabilize spine how
Continue prehospital support ABC
D=disability, assess neuro
-motor assessment
-sensation
-rectal tone
Stabilize spine:
-logroll
-c-collar
Stabilization
Traction
Pin care
If traction becomes displaced: Notify Provider
Decompression sx
Spinal fusion: pos op may need to wear brace/c-collar
Stable injury: no sx needed but may need Halo or Brace
Management
Respiratory
C1-3
C4
C5
Interventions
C1-3: apnea, inability to cough (req vent)
C4: poor cough, diaphragmatic breathing, hypoventilation (check CO2)
C5: decreased resp reserve
Interventions:
Chest PT
Suction
O2
*C5 keep the diaphragm alive
Management
Cardiac
Early problems: shock
-HOTN: vasoactive meds & IVF(1st then meds)
-bradycardia: meds/pacemaker
orthostatic HOTN (d/t decreased SNS)
S/s: lightheaded, dizzy, dec LOC
Tx: abdominal binder, compression stocking (help venous return)
Meds: fludrocortison (inflammation)
DVT prevention
Management
GI
Nutrition: high calorie, protein, fluids and fiber
Constipation risk (fiber)
Neurogenic bowel (cant go)
Bowel training daily at regular time:
-stool softener, laxatives, digital stimulation
-30-60min after meal
-up in chair if possible
Management
GU
Neurogenic bladder
No sensation of bladder fullness
Tx:
Self cath 4-6 times/day
Teach aseptic technique
Teach s/s of UTI
Autonomic hyperreflexia or dysreflexia
What is it
Where injured
What happens below injury
S/s
It is: the Return of reflexes after shock
Injury above T6
Bowel/bladder distension, pain
Vasoconstriction below injury:
>20 risk in BP but can go to 300
S/s
HA, flushing, diaphoresis, bradycardia, nasal stuffiness, seizures
Autonomic hyperreflexia or dysreflexia tx
Pt education when to call for assistace
-Meds to lower BP
-Elevate HOB 45 degrees
-Loosen clothing
-Bladder scan then straight cath
-Digital rectal stimulation
After it subsides: monitor for 3-4 hours
Always check BP when pt with tetraplegia reports HA
Autonomic hyperreflexia or dysreflexia management
Temp
Skin
Stress ulcers
Temp:
Decreased ability to sweat or shiver
No excessive covers
Careful heat loss during bath
Skin: same as always
Stress ulcrs: PPI H2
Autonomic hyperreflexia or dysreflexia management
Pain:
Nocireceptive pain
Neuropathic pain
Reflexes return
Nociceptive pain:
Dull, tender, cramping
Thorax, abdominal, pelvis
Assess bowel and bladder
Neruopathic pain:
Tingling, burning shooting, electric pain
Tx: Gabapentin (neurontin)
Reflexes return:
Penile erection
Spasms
Tx: Baclofen
Autonomic hyperreflexia or dysreflexia management
Male sexuality
Female
Male:
Reflex erections: uncontrolled, cant maintain
ED meds: penile pump external or implanted prosthesis
Fertility but sperm quality is low
Female:
Remains fertile
Cant feel uterine contractions (scary for pregnancy)
Bells palsy
What is it
What nerve is effected
Long it last
Acute peripheral facial paresis
Inflammation facial nerve CN VII
Weeks to months
Unknown cause
Bells palsy CM
Unilateral facial weakness
Numbness: face, tongue, and ear
Tinnitus
HA
Hearing deficit
Decreased muscle tone:
-face droop, flattened nasal labial fold, unable to smile/frown, difficulty chewing
Inability to close eye: risk for corneal abrasions
Bells palsy
Diagnostic test
Tx
R/o stroke: H&P, CT
Tx:
Moist heat, gentle massage
Corticosteroids: done before paralysis
Antivirals: for infection
Chew on unaffected side
Articifial tears, tap eyes shut at night
Guillain-Barre syndrome
Kind of issue
Damage to what
Often preceeded by what
Patho
Autoimmune
Damages peripheral nervous system (polyneuropathy)
Often preceded by GI or URI, vacinnation or sx, and Zika virus
Pathogens: damage to myelin, edema and inflam. of nerves
Guillain-barre syndrome
Diagnostic test
H&P
EMG: measure muscle weakness from polyneuropathy
Nerve conduction studies: slow
Guillain-barre syndrome CM
Begins with
Maximum deficit when
What is involved and some s/s of it
Risk for what
Begins w/: weakness/abnormal sensation in arms & legs
It declines distal to proximal
Return function proximal to distal
Maximum deficit by 2-4 weeks
Sympathetic and parasynmpathetic NS involved=
Orthostatic HOTN, cardiac dysrhythmias, bowel & bladder dysfunction
Risk for respiratory muscle paralysis
Guillian-barre syndrome management
Hospitalized to monitor
Mechanical ventilation possible
Slowed bowels: paralytic illeus
IV ig immunoglobulin therapy (helps w/ antibodies)
Plasmapheresis(exchanging plasma) helps with/ antibodies
Recovery is slow
