Spinal cord trauma/Parkinson's dz/drug abuse Flashcards
injury of c4 or above
quad. may require mechanical ventilation
c4-c5
quad. can control head, neck, shoulder, trap and elbow flexion
c5-6
quad; some extension of wrist, index finger and thumb
c6-7
elbow extension, capable of feeding, dressing
c7-T1
hand movement
T1-T2
paraplegia; upper extremity control but no trunk control
T3-8
some trunk control
T9-10
bowel and bladder reflex, moves trunk and upper thigh
T11-L1
most leg and some foot movement; ambulation possible
L1-L2
lower legs, feet and perineum; continued bowel, bladder and sexual dysfunction if s2-s4 spinal nerves involved
4/5 strength
full ROM against moderate resistance and gravity
3/5 strength
full ROM against gravity, not against resistance
2/5 strength
extremity can move but not against gravity (can roll but not lift)
1/5 strength
muscle contracts but extremity cannot move
management of spinal lesion
- methylprednisolone bolus followed by infusion of 5.4mg/kg/hr for 23 hours. improves neurologic recover when giving within 8 hours of injury
- controversial
complication in T4-T6 injury
may lead to autonomic dysreflexia. an emergency clinical condition
autonomic dysreflexia in t4-6 injury caused by:
exaggerated autonomic response to a stimulus (bladder or bowel distention, or or cold stimulus, restirctive clothing etc)
symptoms of autonomic dysreflexia in T4-6 injury include:
diaphoresis and flushing above the level of injury
- chills and severe vasoconstriction below the level of injury
- HTN, bradycardia
- headache, nausea
Tx for autonomic dysreflexia
antihypertensives and stimulus removal
What may occur with t6 or above injury?
Neurogenic shock
what happens in neurogenic shock
disruption of transmission of sympathetic impulses causes unopposed parasympathetic stimulation which leads to loss of vasomotor tone, inducing massive vasodilation
What results from neurogenic shock and what is used for treatment?
hypovolemia, decreased venous return, and decreased cardiac output result.
sympathomimetic vasopressors are used to maintain blood pressure.
S/S of Parkinson’s
- tremor**: slow, most conspicuous at rest, may be enhanced by stress
- rigidity***
- bradykinesia**
- wooden facies
- impaired swallowing
- drooling
- decreased blinking
- myerson’s sign (repetitive tapping over the bridge of the nose produces a sustained blink response
Mngt Parkinson’s
-increasing available dopamine (Carbidopa-Levodopa, amantadine, tolcapone, pramipexole, ropinirole
What medications help relieve tremor and rigidity
Venztropine and trihexyphenydyl (artane)
What is the leading cause of death for men < 35 years of age
head trauma
workup of head trauma
was there a lucid interval? imp because suggest expanding hematoma.
epidural hematoma a/w lucid interval
decompensating patients. what do they show
signs of bushings triad
widening pulse pressure, decreased RR and decreased HR
Battle’s sign: bruising behind ear at mastoid process
-otorrhea or rhinorrhea
Thoracic injuries involve:
trunk
paraplegia
cervical injuries are about:
hands and arms-variability in use depending on lesion
quadraplegic
major complications of spinal cord injuries
c4 and above: respiratory compromise
T4-6 autonomic dysreflexia
T6 or above: neurogenic shock
what is the triad of Parkinson’s?
tremor
rigidity
bradykinesia (very slow movement)
Parkinson’s patient usually die from what?
pulmonary problem
c/o feet sticking to the floor
vs my tremor is worse treatment differences.
feet: need more dopamine
tremor: need anticholinergic
cervical injuries. what are you assessing to see if they can move
hands and arms. may be svaed
