Week 6 SCI Flashcards
Where do SCIs occur?
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
Do SCIs involve transection of te spinal cord?
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.
Impairments Associated with
SCI
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
Autonomic Dysreflexia:
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
Subjective SCI
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
Neural supply of the
Respiratory System
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)
Breathing Patterns SCI
Epigastric rise Anterior/Posterior movement Lateral flare Intercostal recession Upper chest movement Paradoxical (opposite)
Effect if tetraplegia on lung volumes
Marked effect on all lung volumes except residual volume
What are SCI patients at risk of and how is it managed
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
How does SCI cause hypersecretion/bronchospasmm?
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.
Why is there loss of volume in SCI?
Lack of lateral expansion, don’t have full function of inspiratory muscles & often immobile
Treatment loss of volume SCI
- Use optimal position for ventilation
- Add positive pressure- IPPB, BiPAP,
manual hyperinflations, CoughAssist
machine. - Utilise own effort with Triflow, deep
inhalation/holds, use straws, bubbles. - Manual techniques- rib spring, mobilise
secretions to clear for volume
SCI : Inability to clear secretions – Why?
Lack of force from abdominal muscles,
can’t expel air quickly
Inhalation insufficiency
What could you do? Inability to clear secretions in SCI
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.
Precaution cough assist with patient with unstable cervicle injury
A second person is required to brace the
shoulders of patients with unstable cervical
injuries to prevent movement at the fracture
site
What must tetraplegic patients be taught for safety
All tetraplegic patients need to be taught to
cough with assistance for bronchial hygiene and
in case of emergency i.e. choking
Suction with SCI patients
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
Why is there fatigue in SCI
Fatigue – Why?
Increased WOB due to neuro insult to
inspiratory muscles & expiratory muscles
Ways to address fatigue in SCI patients
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
Signs of deterioration during physio session with SCI are:
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
Respiratory failure SCI
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.
Most common cause of death in SCI
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%.
Tips for SCI
Maximise ventilation Remove secretions Minimise work of breathing Maintain flexibility Monitor neuro status Strength program Educate- individual & family
