Week 6 SCI Flashcards

1
Q

Where do SCIs occur?

A

55% of all SCI are cervical
Remainder are divided equally between
thoracic, lumbar and sacral levels
Most common level of injury is C5, followed
by C4, C6 & T12.
Most mobile parts of the vertebral column

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2
Q

Do SCIs involve transection of te spinal cord?

A

Most SCI don’t involve transection or
severing of spinal cord
Neurological damage due to secondary vascular and
pathogenic events, including oedema, inflammation
and changes to the blood-spinal cord barrier.

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3
Q

Impairments Associated with

SCI

A
 Vertebral damage and instability
 Respiratory dysfunction
 Paralysis
 Paralytic ileus
 DVT and PE
 Spasticity
 Postural hypotension
 Bladder, bowel & sexual function issues
 Pressure areas
 Osteoporosis
 Heterotopic ossification
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4
Q

Autonomic Dysreflexia:

A

Autonomic Dysreflexia:
Uncontrolled parasympathetic response to
noxious stimuli (overstretched bowel,
bladder, cut, sudden change in temperature)
Increase blood pressure (headache, blotchy
rash above level of lesion, blurred vision)
Occurs in people with lesions above T6
Can be life threatening
Sit client up (to lower BP) and look
for cause
SEEK MEDICAL AID IMMEDIATELY

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5
Q

Subjective SCI

A
 Respiration
 Shortness of breath, talking, deep breath,
cough, sputum, bronchospasm, nicotine use
 Neurological
 movement, sensation, spasms
 Pain
 neuropathic/musculoskeletal
 Social History
 Home/family
 Education/job/activities
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6
Q

Neural supply of the

Respiratory System

A
 Diaphragm: C3-C5
 Intercostals: T1-T11
 Abdominals: T5-T12
 Accessory muscles:
SCM: C1-C2 +accessory nerve
Upper traps: accessory nerve
Pect Major: clav. head C5/C6
(Scalenes: C3-C8)
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7
Q

Breathing Patterns SCI

A
 Epigastric rise
 Anterior/Posterior movement
 Lateral flare
 Intercostal recession
 Upper chest movement
 Paradoxical (opposite)
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8
Q

Effect if tetraplegia on lung volumes

A

Marked effect on all lung volumes except residual volume

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9
Q

What are SCI patients at risk of and how is it managed

A

Persons with SCI are particularly at risk from
chest infection due to retained secretions and
inadequate ventilation
Prevention is the fundamental word
Respiratory fatigue most commonly occurs in the
first 24-72 hrs post-injury
Anterior fusion may be associated with increased
sputum production for 24-48hrs due to effect on
the recurrent laryngeal nerve

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10
Q

How does SCI cause hypersecretion/bronchospasmm?

A

Damage to cervical spine interrupts
sympathetic nerve supply to lungs which
originates from the upper 6 thoracic ganglia.
Parasympathetic innervation arising from
vagal nuclei of brainstem remains intact.
SCI may have increased resting airway tone
for this reason & also hypersecretion.

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11
Q

Why is there loss of volume in SCI?

A
Lack of lateral expansion, don’t have full
function of inspiratory muscles & often
immobile
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12
Q

Treatment loss of volume SCI

A
  1. Use optimal position for ventilation
  2. Add positive pressure- IPPB, BiPAP,
    manual hyperinflations, CoughAssist
    machine.
  3. Utilise own effort with Triflow, deep
    inhalation/holds, use straws, bubbles.
  4. Manual techniques- rib spring, mobilise
    secretions to clear for volume
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13
Q

SCI : Inability to clear secretions – Why?

A

Lack of force from abdominal muscles,
can’t expel air quickly
Inhalation insufficiency

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14
Q

What could you do? Inability to clear secretions in SCI

A
1. Need assistance with inhalation &
forced exhalation- use ACBT,
positioning, positive pressure, huff or
assisted cough.
2. Manual techniques – vibes, percussion,
assisted cough, Cough Assist machine.
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15
Q

Precaution cough assist with patient with unstable cervicle injury

A

A second person is required to brace the
shoulders of patients with unstable cervical
injuries to prevent movement at the fracture
site

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16
Q

What must tetraplegic patients be taught for safety

A

All tetraplegic patients need to be taught to
cough with assistance for bronchial hygiene and
in case of emergency i.e. choking

17
Q

Suction with SCI patients

A

Geudel’s airway
may be used if assisted coughing is not
sufficient and is absolutely necessary
Unpleasant and traumatic experience to the
patient and is to be avoided if possible
Pharyngeal suction may result in bradycardia due
to vagal nerve stimulation
Therefore it is essential that the medical staff
are aware and they may stand by with
norephidrine or similar

18
Q

Why is there fatigue in SCI

A

Fatigue – Why?
Increased WOB due to neuro insult to
inspiratory muscles & expiratory muscles

19
Q

Ways to address fatigue in SCI patients

A
What could you do?
1. Decrease effort to breathe- position,
assist inspiration, clear obstructions
to allow optimal breathing
2. NIV- IPPB, BiPAP, CPAP
3. ICU- intubate/sedate/rest
20
Q

Signs of deterioration during physio session with SCI are:

A
 drowsiness and lack of concentration
 slurring of speech
 decreased ability to co-operate with coughing
etc
 altered respiratory rate
 decreased RFTs / FVC
 decreased AE on auscultation
 increased production of sputum +/- colour
change
21
Q

Respiratory failure SCI

A

Inadequate gas exchange by the respiratory
system, with the result that arterial O2 &/or
CO2 levels can’t be maintained within normal
ranges.
The risk of respiratory failure is directly
associated with the level of injury.
Within these critical first few days, the
diaphragm and other respiratory muscles may
fatigue.
Pulmonary compliance deteriorates rapidly
because of poor lung expansion and decreased
production of surfactant.

22
Q

Most common cause of death in SCI

A
 Respiratory complications are the most
common cause of morbidity and mortality in
acute SCI. 80% of deaths in cx SCI are
secondary to pulmonary dysfunction with
pneumonia the cause in 50%.
23
Q

Tips for SCI

A
 Maximise ventilation
 Remove secretions
 Minimise work of breathing
 Maintain flexibility
 Monitor neuro status
 Strength program
 Educate- individual & family