Week 8 Oxygenation Perfusion SCI Flashcards
Hyperflexion SCI
head is suddenly and forcefully accelerated forward, causing extreme flexion of the neck.
often occurs in car accidents
Head tilts forward
Hyperextension SCI
head is suddenly accelerated and then decelerated.
Head tilts back
Axial loading SCI
Diving accidents, falls on the buttocks, or a jump in which a person lands on the feet
Examples of secondary SCI
Hemorrhage, Ischemia, Hypovolemia and Neurogenic shock (a medical emergency)
Priorities in initial assessment of SCI
ABC High resp risk Hemorrhage LOC (possible TBI) Motor and sensory status for baseline
Spinal shock
occurs immedieatly after injury and lasts 48 hours to weeks
Loss of motor, sensory, reflex, and autonomic function
Cardiovascular changes caused by loss of sympathetic input in SCI
Bradycardia, hypotension and hypothermia may lead to dysrhythmias
At what systolic level does hypotension need tx and why
below 90 mmHg because there may be a lack of perfusion to the spinal cord
Common respiratory complications after SCI
atelectasis, pulmonary emboli and pneumonia
Paralytic ileus
GI complication of SCI
Develops within 72 hours due to decreased peristalsis is spinal shock
Abdominal bleeding in SCI
Hemorrhage may occur from trauma or stress ulcers from steroid use
Result of LMN lesions
flaccid muscle paralysis leading to muscle wasting
Result of UMN lesions
muscle spasticity which can lead to contractures
Hypertrophic ossification
complication of immobility
bony overgrowth into muscle
Urinalysis after SCI
testing for hematuria after trauma
Respiratory tests after SCI
End tidal CO2 or ABG to monitor resp status
CO2 and respiratory acidosis = respiratory failure
Blood tests after SCI
Check for low hemoglobin, leukocytosis, lymphocytopenia, and thrombocytopenia indicating lack of autonomic innervation to the hematopoietic (blood-cell producing) system.
Imaging assessment after SCI
CT or MRI to determine damage to spinal cord and presence of blood
Full x-rays should also be done
6 priority problems for SCI patients
- difficulty breathing (UMN injury)
- Neurogenic shock (mostly T6 and above)
- Further SCI r/t swelling/fractures
- Impaired mobility/ self care
- bowel/bladder dysfunction
- Maladjustment
Interventions to prevent neurogenic shock
adequate hydration through PO and IV fluid
Who is at risk for neurogenic shock?
SCI above T6 within 24 hours of injury
Flaccid bladder
LMN injury
may achieve continence using valsalva maneuver
Key features of autonomic dysreflexia
Sudden severe, throbbing HA Severe, rapid HTN Bradycardia Flushing above lesion (face and chest) Pale extremities below lesion Nasal stuffiness Sweating Nausea Blurred vision Piloerection Feeling of apprehension
Immediate interventions for autonomic dysreflexia
#1 Sit Pt up loosen clothing Asses/ treat cause (urinary, bowel, temp) Monitor BP Give nitrates
