Spinal Shock

Question 1

Temporary suppression of reflexes controlled by the segments below the level of injury and usually happens after an injury.

Answer 1

Spinal Shock

Question 2

List the clinical manifestation of spinal shock.

Answer 2

FAHALVI
Flaccid paralysis 
Absence of cutaneous and proprioceptive sensation 
Hypotension and bradycardia 
Absence of reflex activity below the level of injury 
Loss of temperature control 
Vasodilation and inability or shiver 
Inability to perspire

Question 3

Weakness or paralysis of upper extremities greater than lower extremities. Sensory loss greater in upper than lower extremities.

Answer 3

Central Cord Syndrome

Question 4

Paralysis. Loss of pain and temperature with preservation of vibration and position sense.

Answer 4

Anterior Cord Syndrome

Question 5

Loss of vibration and position sense with preservation of pain and temperature sensation

Answer 5

Posterior Cord Syndrome

Question 6

Ipsilateral loss of vibration and position sense with contralateral loss of pain and temperature sensation

Answer 6

Brown sequard syndrome

Question 7

Injury that continues for hours to days after initial trauma

Answer 7

Secondary Injury

Question 8

Surgical management for spinal shock

Answer 8

Laminectomy
Spinal fusion
Rodding

Question 9

Non-surgical management for spinal shock

Answer 9

Skeletal traction
Kinetic therapy bed
Halo traction
Body cast/ fiberglass jacket/ brace

Question 10

TRUE OR FALSE: In airway management, the use of succinylcholine is encouraged to cause a massive release of skeletal muscle potassium

Answer 10

FALSE: Do not use, can lead to hyperkalemia then cardiac arrest

Question 11

What positioning creates a downward displacement of the diaphragm and increases the intercostal retraction

Answer 11

Upright positioning

Question 12

__ positioning can improve respiratory function in patients with cervical / thoracic SCI

Answer 12

Flat positioning

Question 13

At what rate, Maximal Inspiratory Pressure (MIP) and vital capacity should be assessed

Answer 13

At least (-) 20 cm H20 
> 10-15 mL/kg

Question 14

If less than MIP and Vital capacity, what does it mean?

Answer 14

Candidate for Mech Vent

Question 15

In hemodynamic support for spinal shock, what should we watch out for?

Answer 15

Hemorrhage and neurogenic shock

Question 16

In hemodynamic support, what medication or medical management can be given since bradycardia after SCI can be profound and may progress to asystole

Answer 16

Atropine/ Pacemaker Placement

Question 17

A medication in spinal shock that counter the loss of sympathetic tone and provide inotropic (increase strength) and chronotropic (increase rate) support (use for hypotensive; good for cardiac contraction)

Answer 17

Norepinephrine (Levophed)

Question 18

True or false: Adeauete volume replacement unless contraindicated e.g. pulmonary edema is provided in hemodynamic support.

Answer 18

True

Question 19

BP Augmentation - MAP should be what for the first 5th-7th?

Answer 19

> 85 mm Hg

Question 20

During the immediate post-injury period, patients experience musculoskeletal and neuropathic pain, What drugs can be given?

Answer 20

Opiates - muscle relaxants

Gabapentin and Pregabalin - for neuropathic pain

Question 21

Respiratory complications are one of the most common complications of spinal shock. What is the most common cause of death in terms of respiratory?

Answer 21

Pneumonia