Unit 10: SCI Flashcards
How to prevent secondary (makes the primary worse) SCI?
Surgery within 24hrs
Immobilize spine with halo or collar
Drug therapy
Preventive/reversible during the first 4-6 hours after injury.
What are secondary injuries/complications for SCI?
Hemorrhage, ischemia (lack of O2, reduced blood flow), hypovolemia, impaired tissue perfusion (from neurogenic shock), local edema
What are complete SCI vs incomplete?
A complete is when the spinal cord is damaged in a way that eliminates all innervation below the level of injury.
An incomplete allows some function or movement below the level of injury
What is the Brown-Sequard syndrome?
Definition: A neurological condition caused by damage to one side of the spinal cord.
Symptoms:
- Same side (ipsilateral): Loss of motor function (paralysis/weakness) and proprioception/fine touch.
- Opposite side (contralateral): Loss of pain and temperature sensation.
Causes: Trauma, tumors, infections, multiple sclerosis.
Treatment: Surgery, steroids, physical therapy.
What is the central cord syndrome?
Definition: A spinal cord injury that primarily affects the central portion of the cervical (neck) spinal cord.
Symptoms:
- Upper limb weakness (more severe than lower limbs)
- Sensory loss (pain/temperature sensation in upper limbs)
- Bladder/bowel dysfunction (may occur)
Causes: Trauma, spinal stenosis, degenerative conditions (e.g., spondylosis)
Treatment: Stabilization, surgery (if needed), rehabilitation (physical/occupational therapy)
Prognosis: Variable; many improve with therapy, but recovery can be incomplete.
What is the anterior cord syndrome?
Definition: A spinal cord injury affecting the front (anterior) part of the spinal cord, leading to motor and sensory deficits.
Symptoms:
- Motor paralysis below the level of injury.
- Loss of pain and temperature sensation below the injury.
- Preserved touch and proprioception.
Causes: Trauma, ischemia, tumors.
Treatment: Stabilization, surgery (if needed), rehabilitation.
Prognosis: recovery rates are 10%-20%
What is spinal shock?
Spinal shock is right after the primary injury occurs. This shock makes the symptoms of the injury appear worse. Over time (days to months), this shock wears off, and patients will truly see what function they have left.
S/S: loss of spinal reflexes (reactive reflexes - burning stove top), flaccid paralysis (depression of reflex activity below the level of spinal injury), loss of perianal reflexes (constipation or diarrhea)
What are the levels of injury for tetraplegia?
C1-C3: Complete paralysis of all limbs; requires ventilator.
C4-C5: Elbow flexion, no hand function; may require assistance with daily tasks.
C6-C8: Wrist-elbow control, partial hand function; independent wheelchair use.
What are the levels of SCI? Functionality?
T1-T5: Full arm function, upper trunk weakness; wheelchair mobility.
T6-T12: Trunk and core control; may walk with assistance.
L1-L3: Hip flexors and leg muscles weak; possible walking with braces.
L4-L5: Leg function improved; some ability to walk without assistive devices.
S1-S5: Some leg movement, intact bladder/bowel control; may walk independently.
What are interventions for SCI?
Oxygenation
Immobilization
Medication
Surgery within 24 hrs - restore the spine to normal position
Halo traction: assess pins (clean with hydrogen peroxide), weights are used to align the bones, dangle weights free to not interfere with traction
What is autonomic dysreflexia? Tx?
Exaggerated response to stimuli that causes seizures, stroke, and death
StimulI: distended bladder, constipation, stimulation of skin, pain, pressure ulcer, sexual activity, menstrual cramps, labor/delivery, bone fractures
S/S: headache, increase BP, severe vasoconstriction, blotching, goose bumps, red face, cold/clammy skin, nasal congestion, blurred/spots in vision, bradycardia
Tx: place in seated position, eliminate cause, Nipride/hydralazine, label chart with risk of AD, Educate patient in prevention/management
What is dextran, atropine sulfate, dopamine, nifedipine, nitrate, LMWH, calcium, bisphosphonates, and baclofen
Dextran: plasma expander to increase cap blood flow and BP
Atropine sulfate: bradycardia (neurogenic shock)
Dopamine: given in continuous IV to increase BP
Nifedipine:
Nitrate:
Baclofen: control muscle spasticity
Low-molecular-weight-heparin: prevent ventricular thromboembolism
Calcium and bisphosphonates: prevent of osteoporosis
What is the assessment of SCI?
Monitor respirations, breathing patterns, lung sounds, and cough
Watch for Bradycardia, low Systolic BP (decreased perfusion), and hypothermia
Understand orthostatic hypotension is common
Monitor for changes in motor or senses
Assess for spinal and neurogenic shock
Monitor for bladder and bowel function
Watch for hyperthermia - increased need for O2 by the brain increases temperature
What is sexuality with SCI?
Refer them to a sexuality/intimacy counselor
Be empathetic, but refer!
What changes in thermoregulation occurs with SCI?
Where the injury effects cannot have proper thermoregulation. They often cannot sweat and will easily overheat due to loss of sensation.
What is the management and complications of patients with decreased mobility?
Pressure injuries
Venous thromboembolism
Contractures
Orthostatic hypotension - move slowly
Fractures from osteoporosis
What instructions are needed for X-Ray, CT, and MRI?
X-ray: hold still - shows bone injury
CT: feels like you are peeing
MRI: takes long, hold still - no metal
What is hyperextension in SCI? Hypoextension?
Hyperextension: a sudden and forceful movement/acceleration of the head forward, causing extreme flexion of the neck
Hypo-extension: the head is suddenly accelerated and then decelerated
What is neurogenic shock in relation to SCI?
SCI at T6 or above
May occur within 24hrs of injury
Can persist for around 1 month
Tx: dextran for low BP and atropine for low HR
