Week 6 - Spine/Spinal Cord Disorders

Question 1

Acute spinal cord injuries occur predominately in what population?

Answer 1

16-30 year old Males

Question 2

What is the most common spinal cord injury, Thoracic, Lumbar or Cervical? What % of all major traumas?

Answer 2

Cervical
* 1.5-3%

Question 3

Causes of non-traumatic SCI?

4

Answer 3

• Epidural Hematoma
• Abcesses
• Degenerative disease
• Two-mer

Tumor

Question 4

What is the definition of a complete SCI?

Answer 4

Total loss of motor/sensory below level of injury

Question 5

What is the definition of an incomplete SCI?

Answer 5

Some function remains below primary level of injury

Question 6

What hemodynamic concern may occur with a spinal cord injury above T6?

Answer 6

Spinal Shock

Question 7

Spinal shock occurs at an spinal level of?

Answer 7

T6 or Above

Question 8

What kind of shock is spinal shock? What is occurring?

Answer 8

Distributive shock
* Loss of sympathetic tone

Question 9

What hemodynamic markers might you see in a pt experiencing spinal shock?

Answer 9

• HoTN
• Bradycardia

Question 10

What are the hemodynamic goals in a pt experiencing spinal shock?

Answer 10

• MAP > 85-90mmHg for 5-7 days

Question 11

How do you maintain a MAP in a spinal shock pt?

3

Answer 11

• Fluid resuscitation
• Blood Transfusion
• Vasopressors
  for first 72 hrs

Question 12

What are the s/s of Autonomic Hyperreflexia?

5

Answer 12

• Bradycardia
• Flushing
• HA
• Diaphoresis
• ↑ BP

Question 13

In what kind of SCIs can Autonomic Hyperreflexia be observed? What kind is incidence low?

I’ve been living my life thinking it was called dysreflexia

Answer 13

SCIs above T6
* Below T10

Question 14

What triggers Autonomic hyperreflexia?

Answer 14

Noxious stimuli below level of injury
* Bladder/Rectal stimulation

Question 15

Consequences of untreated, severe AH?

5

Answer 15

• HTN crisis
• Intracranial hemorrhage
• Seizure
• Cardiac arrest
• Stroke

Question 16

Anesthetic considerations for Autonomic Hyperreflexia?

3

Answer 16

• Consider Neuraxial
• Deepen anesthetic if under GA
• Tx severe HTN w/ fast acting/titratable agents

Question 17

What are some fast-acting, titratable agents (and doses) that could be used to treat intraoperative Autonomic hyperreflexia?

4

Answer 17

• SNP: 0.5-3 mcg/kg/min
• Nitroglycerin: 5-200 mcg/min
• Hydralazine: 10-20 mg
• Phentolamine: 5 mg

Question 18

What is Amyotophic Lateral Sclerosis also known as?

Answer 18

Lou Gehrig’s

Question 19

Most common cause of death in pts w/ ALS/Lou Gehrig’s?

Answer 19

Respiratory Failure

Question 20

Causes of ALS?

Answer 20

• Hereditary: 5-10% of cases
• Environmental toxin exposure

Question 21

What are some environmental toxins that may lead to ALS?

5

Answer 21

• Lead
• Pesticides
• DDT (insecticide)
• Military Service
• Smoking

Question 22

Always a doozy, what are s/s of ALS?

7

Answer 22

• Weakness in hands, legs, feet, or ankles
• Difficulty walking/ADLs
• Slurred Speech/Trouble swallowing
• Muscle cramps/fasciculations
• Cognitive/Behavior changes
• Orthostatic HoTN/Tachycardia
• Lung CA

Question 23

Respiratory symptoms of ALS?

6

Answer 23

• SOB
• Weak cough
• Extra Saliva
• Inability to lie flat
• Chronic infections/PNA
• Respiratory Failure

Question 24

When should succinylcholine be avoided in a pt experiencing an acute and now chronic SCI?

Answer 24

after 24 hrs - 6 months

Question 25

How might you intubate a pt with an acute (< 24hrs) C4 injury with a full stomache?

Answer 25

Give succinylcholine for RSI w/ in-line Manual stabilization

Question 26

What position might you intubate an ALS pt in?

Answer 26

HoB elevated or Reverse T-burg