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Critical Care Exam 4 > Spinal Injury > Flashcards

Spinal Injury Flashcards

1
Q

What level of respiratory function does a C1-C2 patient have?

A

paralysis of diaphragm

ventilator dependent

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2
Q

What level of respiratory function does a C3-C5 patient have?

A

various degrees of diaphragm paralysis.

Some diaphragm control may need vent support weaning depends on preinjury pulmonary status.

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3
Q

What level of respiratory function does a C6-T11 patient have?

A

various degrees of impaired intercostal muscles and abdominal muscles.
Compromised resp function reduced inspiratory ability paradoxical breathing patterns ineffective cough and sneeze

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4
Q

C1-C4 functional ability

A

requires electric wheelchair with breath head or shoulder controls

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5
Q

C5 functional ability

A

needs electric wheelchair with hand control and/or manual wheelchair with trim projections may require adaptive devices to assist with ADLs.

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6
Q

C6 functional ability

A

independent in manual wheelchair on level surface may need hand controls adaptive devices may be needed for ADLs.

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7
Q

C7 functional ability

A

requires manual wheelchair on most surfaces.

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8
Q

C8-T1 functional ability

A

may need adaptive devices

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9
Q

C8-T1 functional ability

A

may need adaptive devices

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10
Q

ASIA A

A

A = Complete : No motor or sensory function is preserved in the sacral segments S4-5. (sensation or motor function at anal opening)

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11
Q

ASIA B

A

B = Incomplete: Sensory but no motor function is preserved below the neurological level and extends through the sacral segments S4-5. (anterior cord pts)

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12
Q

ASIA C

A

C = Incomplete: Motor function is preserved below the neurological level and the majority of key muscles below the neurological level have a muscle grade less than 3. 3- can bring it against gravity, not walking

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13
Q

ASIA D

A

D = Incomplete: Motor function is preserved below the neurological level, and the majority of key muscles below this level have a muscle grade greater than or equal to 3. Part time walkers

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14
Q

ASIA E

A

E = Normal: Motor and sensory function is normal. Might be on bowel and bladder program

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15
Q

What is the significance of the phrenic nerve?

A

The phrenic nerve is important due to the fact that it sends signals to initiate breathing in the diaphragm and there is a R&L nerve

Pair of nerves that arise from the cervical spinal roots (C3) & passes down the thorax to innervate the diaphragm & help control breathing.
C3 fracture of injury can’t be phrenic nerve paced

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16
Q

What is meant by a complete injury?

A

It results in the total loss of sensory and motor functions below the level of injury.
Which results in complete dissection of the spinal cord.
Tetraplegia- injury that happens C1-T1.
Parapalegia involves T2-L1 and these patients may just need a wheelchair since they might have full use of their arms.

Motor & Sensory neural pathways completely transected and total loss of sensory & motor function below the level of injury through the S4-S5. No movement or feeling below the zone of injury. (Ex: tetraplegia or paraplegia)

17
Q

An incomplete injury?

A

mixed loss of voluntary motor activity and sensation below the level of the lesion.
This injury exists if any function remains below the level of injury.

Partial preservation of sensory and/or motor function below neurological level of injury including S4-S5. Has movement and / or feeling below the site of injury, some level of movement and sensation below the level of injury. (Ex: Brown-Sequard, Central, Anterior, and Posterior Cord Syndrome)

18
Q

If a patient loses “Vasomotor” tone due to a spinal cord injury, what effect will that have on blood vessels? Will they constrict more or vasodilate more?

A

the vessels would vasodilate which would result in orthostatic hypotension.

Vasomotor is a sympathetic nervous system response providing a degree of tension to the smooth muscle within the walls of blood vessels (giving a constant nervous stimulation to maintain a resting level of contraction). It will maintain the diameter of the blood vessels & will maintain BP. A loss would cause a massive vasodilation which will lead to a neurogenic shock (hypotension, bradycardia, and hypothermia)

19
Q

Anterior Cord Syndrome Clinical Application

A
  • Loss of movement and pain sensation.
  • Preserved touch and proprioception.
  • Presents with paralysis and loss of pain sensation but has spared touch and proprioception .
  • Most common
  • Will have to be the eyes of the pt, because can’t feel if they are sitting on something or if developing skin injuries/pressure ulcers – DON’T FEEL PAIN AND TEMP
20
Q

Brown Sequard Syndrome Clinical Application

A
  • Loss of movement and touch / proprioception sensation ipsilateral side.
  • Loss of pain sensation contralateral side.
  • Presents like hemiplegia and loss of pain sensation on good side.
  • 2nd most common
  • – lost touch and perp on L, movement of L, and pain and temp of R
  • Weak side is the side that feels pain and temp the best so needs to test hot water with weak side
21
Q

Central Cord Syndrome

A
  • Greater loss of movement / sensation to the upper extremities vs. lower extremities.
  • Pressure around whole spinal cord
  • Loss of arm function greater than loss of leg function
  • Diving injury
  • Pt walk into clinic with arms paralyzed
22
Q

Posterior Cord Syndrome

A
  • Loss of proprioception.
  • Generally spared movement and sensation to pain.
  • Pt presents with poorly coordinated movements.
  • Can’t feel touch
  • Can move with pain and temp attatched
  • Least common – tumor pts
23
Q

Why is dexamethasone (Decadron) given to a SCI patient?

A

It is given because it can help improve the patient’s neurological outcome

Improves the neurological outcome and prevents post-traumatic spinal cord ischemia, improves energy metabolism, restores extracellular Ca+, and improves nerve impulse conduction.

24
Q

What is the purpose of a Halo vest?

A

The halo vest is a metal ring that is secured to the skull with two occipital and two temporal screws. The brace immobilizes the spine which allows the patient to ambulate and participate in self-care.

25
Q

Upper Motor Neurons

A
  • The Brain and Spinal Cord
  • No ability to regenerate.
  • Damage to UMNs results in increased reflex activity.

consist of the brain and spinal cord; no ability to regenerate neurons. Damage results in increased reflexive activity (Spasticity), the reflex arc remains intact- reflex message is sent up the spine but doesn’t make it to the brain which means the brain is unable to tell it to stop. Muscles will contract over & over and the patient will be hyperreflexive with a spastic bladder causing incontinence.

26
Q

Lower Motor Neurons

A
  • Spinal Nerves
  • Ability to regenerate under right circumstance.
  • Damage results in reduced or absent reflex activity.
  • Carpal tunnel
  • Peripheral nerve injury – peripheral neuropathy may loss reflexes

Everything else in the periphery including the cauda equine, the spinal nerves. They have the ability to regenerate under the right circumstances, Damage results in reduced or absent reflex activity. The reflex can’t make it to the spine for the reflex arc, so no reflex occurs and this will cause a flaccid bladder (overfill incontinence)- called Autonomic dysreflexia.

27
Q

Autonomic Dysreflexia

A
  • Crisis for spinal cord injuries at or above T6.
  • Present with elevated blood pressure due to stimulated sympathetics to blood vessels below the level of injury.
  • Bradycardia due to the vagal (cranial nerve X) response to hypertension.
28
Q

Autonomic Dysreflexia Symptoms

A
  • Hypertension
  • Pounding Headache
  • Bradycardia
  • Nasal Congestion
  • Sweating above level of injury
  • Skin flushing above level of injury
  • Goose bumps above level of injury
  • Chills without fever
29
Q

Autonomic Dysreflexia what happens

A

Painful stimuli → postganglionic release of norepi → vasocontriction (sympathetic response) → hypertension (headache)
First response: Parasympathetics → excites cholinergic receptors in the heart (bradycardia) → not enough to counterbalance vasoconstriction
Second Response: Inhibitory response to above sympathetics with vasodilator activity ravels down lateral horn of SC (T1-L2) → spinal cord injury at or above T6 → continued vasoconstriction below the injury → vasodilation above the injury (flushing sweating)

30
Q

What are complications a SCI patient can expect to experience?

A

VTE, (DVT, PE), common misdiagnosis of acute abdomen, pressure ulcers, muscle atrophy, contractions, UTI, areflexic/hyperreflexic bladder, sexual dysfunction, high Ca+, high Phos, hypotension (low BP), bladder & kidney stones, heterotrophic ossification, postural deviations that can lead to structural deformity, weight gain, loss of thermoregulation (poikilothermic), decreased cough reflex- causing atelectasis, constipation, and impaction.

31
Q

Autonomic Dysreflexia treatment

A

Treatment aimed at alleviating noxious stimuli- is to remove catheter kinks, empty bag often, irrigate the catheter, remove impaction, loosen clothing, inspect toe nails, turn and relieve pressure, and elevate the HOB

32
Q

If no upper neuron motor control reflexes are

A 
very exaggerated (Hyperflexic) 
so spastic bowel and bladder 
Only thing intact is lower motor neurons
33
Q

If no lower motor neurons then reflexes are

A

absent.

bladders will be flaccid (will fill and fill and fill but not empty) have to self cath

34
Q

If L3 injury reflexes

A

– message does not get to spinal cord, so no loop back for relflex to happen
do not have reflexes – bc can’t get to spinal cord, flaccid everywhere
bladder fills up, no reflex happens, and keeps filling, if don’t cath keep filling and keep filling, don’t empty, flaccid bladder
o Lower motor neuron injuries

35
Q

T6 injury reflexes

A

– pt does not feel, and brain doesn’t know, reflex happens and brain has lost control

36
Q

C6 injury reflexes

A

– reflexes are hyperflextic

37
Q

spinal cord injury reflexes

A

stretch reflex – bladder doesn’t empty completely T6, if don’t cath will have accident

Critical Care Exam 4 (4 decks)

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