Week 8 - Spinal Cord Injuries Flashcards
Treatment for autonomic dysreflexia?
Treatment:
-Sitting pt upright
-Monitor VS
*Remove offensive stimuli
-Antihypertensive meds
Treatment: Lower BP (sit patient upright), most important thing we need to do is remove the offensive stimuli (empty bladder)
What do triggers for autonomic dysreflexia do/cause?
Triggers an exasperated vasoconstriction below the level of injury…. Shoots BP up due to vasoconstriction, Bradycardia due to brain telling the heart to slow down!
Complete Vs Incomplete SCI? (what kind of chance does each have for a functional recovery?)
What is a complete SCI?
Total loss of sensory and motor function below level of injury
Very low chance of functional recovery
What is an incomplete SCI?:
Partial preservation of sensory or motor function below level of injury
Potential for some functional recovery
What is a rotational SCI? what causes them/is their MOI?
Definition:
Twisting of the spine
Extreme lateral flexion or twisting of the head and neck
Mechanism of Injury?
T-Boned MVC’s
Blows to the head (boxing/assaults)
What is an incomplete SCI?
-What is the potential for preservation of sensory or motor function/is there a chance for it?
-What can there be?
Incomplete SCI: Partial preservation of sensory or motor function at and below the level of injury!
-There is potential for some functional recovery!
-There can/would be crossover when it comes to partial spinal cord injuries!!
In developing countries what are the main causes of death for SCIs?
Preventable complications are the main cause of death in developing countries
what kind of interventions is needed for Below an L2 – L3 – L4 ?
Below an L2 – L3 – L4 – need different walking aides
S+S for neurogenic shock? (6 main ones)
Signs and Symptoms:
-Loss of sympathetic response
-Peripheral vasodilation below the level of the injury (brain can’t communicate with nervous system below injury)
-Low blood pressure (hypotension)
-Impaired thermoregulation - poikilothermic
-Bradycardia
Skin is going to look bright red and flushed below the level of injury due to the blood pooling in that area
For our primary survey with SCIs what interventions/what do we do during our primary survey? (6 main/different things)
Primary survey:
- C-spine and back board - Don’t want to keep back board on for to long due them causing skin breakdown faster
-Jaw thrust (no head-tilt-chin-lift)
-Caution suctioning (can stimulate vagus nerve)
-High flow O2 (resp muscle impairment)
-Circulatory assessment
-Disability – reassure patient
What is an example of a minor hyperextension injury?
-Whiplash - minor
What medication can we give our patient to avoid hypotension to ensure injury site still gets adequate perfusion?
Atropine can be giving – don’t want patient to become hypotensive because we still need adequate perfusion to the injury site
S+S for spinal shock? (4 of them)
Signs and Symptoms:
Flaccid paralysis
Absence of cutaneous / proprioceptive sensation
Loss of autonomic function
Suppression of reflex activity below the site of injury
Complications for hyperextension injuries?
Complications:
-Stretch or tear of the anterior longitudinal ligaments
-Possible fracture to arch
-Subluxation of the vertebrae (a partial dislocation/a slight misalignment of the vertebrae)
-Rupture of the disks
During our secondary survey for SCIs what can we be doing/assessing? (4 main things)
Secondary survey:
1.) Log-roll patient
2.) Rectal tone
3.) Motor and sensory function (spinal tracts)
Noxious stimuli
4.) Reflex functions
What is autonomic dysreflexia? What system does it impact?
Definition:
-SCI T6 or above
-Uncontrolled, massive sympathetic reflex response to a pain/discomfort stimulus below the level of the lesion (often full bladder/bowel)
-It is considered a medical emergancy!!
-Impacts autonomic system
Treatment for neurogenic shock?
Treatment:
-Prevent cardiovascular instability
-Promote optimal tissue perfusion (treat bradycardia)
-SBP>90 and MAP from 85-90 for the first seven days
-Administer atropine to help restore patient BP
Primary treatment is to help maintain the patients BP so that adequate tissue perfusion of the spine can occur!
For spinal shock what are we as nurses doing?
Ongoing VS/Reflex monitoring
What do we need to understand with SCIs?
Understand that there still can be injuries that are occurring below the injury that the patient might not even be aware of due to their inability to feel below the injury site
Noxious Stimuli
What are soft tissue injuries? what do/can they cause?
Soft Tissue Injuries:
-Muscles, ligaments are stretched
They cause: Edema/microhemmorhages cause pain/spasms/headache
S+S of autonomic dysreflexia? (below and above injury)
Signs and Symptoms:
-Below injury – severe vasoconstriction
-HTN, Bradycardia
-Above injury – vasodilation
-Facial flushing, pounding headache, sweating, anxiety
What is spinal shock? what causes it?
Definition: Transient suppression of reflexes below spinal cord injury. Think “concussion” of spine.
-Transient = They improve over time!!!!! - Can take days, weeks, months and/or years for function to come back
-Only temporary
Cause by: Edema, inflammation, possible bleeding causing temporary ischemia
What kind of SCI is Neurogenic shock?
This is a primary injury due to the body being in shock!
What are 9 different ways we manage SCIs?
1.) Bone Stabilization
-We want to stabilize the bones/spinal cord so we can avoid further injury!
-We stabilize with surgical fixation, traction, and collars
2.) Respiratory Support
-Want to make sure our patients are still breathing and alive
-Do this with ventilators, oxygen, medications, positioning, physio, suction, binders
3.) Cardiovascular Support
-Monitor patients BP
-Have patient wear compression socks to avoid DVTs!
4.) Gastrointestinal Support
-Patient won’t be able to move so a G tube will be inserted to ensure patient
is getting nutrients!
-Administer medications like laxatives to ensure patient doesn’t get
constipated!
5.) Skin Integrity
-Patient will be in bed so ensure you monitor them for pressure sores +
reposition them!
6.) MSK Support
-Monitor patient for contractures and spasticity!
7.) Urinary Retention
-Monitor patient for UTI, foley will most likely be in
place!
8.) Other Medications
-Analgesics, steroids for swelling, etc.
9.) Coping
-This is a new and very scary time for the patient,
patients will require a lot of support with adjusting to
their new reality
What is a traumatic SCI/when does it occur? (definition)
Occurs when an external physical impact, such as that resulting from a motor vehicle collision, fall, or from violence, damages the spinal cord. Varying degrees of motor and/or sensory deficits, or paralysis, may be present.
Where on the spine is high Quadriplegia?
High Quadriplegia: above C4
What is Tetraplegia (Quadriplegia)?
-where does the injury occur?
-what system does it impact?
-where does the Paralysis occur?
Tetraplegia (Quadriplegia):
Injury to T1 and above
Paralysis of lower and upper portions of the body
Autonomic Nervous System not functioning properly
High Quadriplegia: above C4
What is Neurogenic shock? what causes it?
Definition: Inadequate tissue perfusion due to lack of normal innervation from the sympathetic nervous system that keeps arterioles constricted
-We don’t have enough pressure occurring to properly perfuse our spinal cord
-Classic shock
Causes:
SCI at T6 or above
Disrupts the Sympathetic Nervous System
Where does damage occur/what kind of injury is a hyperextension injury?
-Damage to the cervical vertabre – much higher level of spinal injury
What is important to know about injuries at C4 and above?
C4 and above – about a third die at the scene! This is due
to the impact on the respiratory system and the patient
no longer having the ability to
independently/automatically breath on their own!!
REMEMBER anything above a C4 impacts the respiratory
system causing patients to lose the ability to
automatically/independently breath! (UNDERSTAND
THIS LEVEL!!)
What do we do for penetrating SCI injuries?
Penetrating Injuries:
Primary issue: deal with the ABCs to stablize patient/keep them alive long enough to get them to the or….then rush OR
What is Paraplegia?
-where does the injury occur?
-What function is preserved?
Paraplegia:
Injury of T2 or below
Arm and hand function preserved
High: T2-T6
Low: T7 or below
Complications for hyperflexion injuries? and what do they require?
Complications:
Posterior ligament damage, vertebrae become dislocated and require immediate surgical stabilization
*Requires immediate cervical stabilization
Causes of a complete SCI? and what does it result in?
-Loss of all voluntary muscle control and sensation at and below the level of lesion
Causes:
Severance of cord
Stretching of cord
Ischemia of cord
Treatment for soft tissue injuries?
NSAIDS, Heat, Genterl exciersie, time
What are hyperflexion injuries? What is their MOI/what causes them?
Definition:
Spine receives direct/indirect blow toward the anterior surface of the vertebral body
Flexion beyond normal ROM
*Head keeps moving while the body stays in place
Mechanism of Injury:
Head on MVC’s
What are Noxious stimuli? What do we need to understand?
Noxious Stimuli*: A stimulus that is actually or potentially damaging to tissue, and liable to cause pain.
Noxious stimuli can either be mechanical (e.g. pinching or other tissue deformation), chemical (e.g. exposure to acid or irritant), or thermal (e.g. high or low temperatures). There are some types of tissue damage that are not detected by any sensory receptors, and thus cannot cause pain.
Understand that there still can be injuries that are occurring below the injury that the patient might not even be aware of due to their inability to feel below the injury site
How long does spinal shock last for? what kind of recover does it have?
-It is transien!! = This means that the patient improve over time!!!!! - Can take days, weeks, months and/or years for function to come back
Gradual recovery:
Ongoing VS/Reflex monitoring
Duration:
Days – Weeks
What is a Compression/Axial Loading injury? what causes them/is their MOI?
Definition:
Force exerted vertically through the spinal column
Pressure pushed down onto the spine
Mechanism of Injury:
Shallow diving
Sports injuries
Falls / Jumping
Thoracolumbar most common
Cervical second common
What are hyperextension injuries? What is their MOI/what causes them?
Definition:
Extreme extension of the spinal column
-Damage to the cervical vertabre – much higher level of spinal injury
Mechanism of Injury:
-Fall
-Rear-Ended MVC’s
-Older vehicles without tall headrests
-Whiplash - minor
Is neurogenic shock perminant? how long can it last for?
Not perminant, but can last for a couple of weeks
How do we diagnose SCIs? (think of 2 outside of imaging)
Diagnostics:
FAST, Spinal Xrays, or CTs
Toxicology, ABGs
what kind of interventions is needed for injuries at C4 – T4?
varying degree of chest interventions needed
Complications for Compression/Axial Loading injury?
Complications:
Vertebral bodies and discs attempt to absorb the energy and burst
Bone fragments in the spinal canal
Compression of spinal cord
Complications of a rotational SCI?
Complications:
Stretch and rupture posterior ligaments
Dislocate facets (joints between vertebrae)
Compression fracture of bony structures
What is the most common demographic + age group to experience an SCI? Why?
Men aged 20-29 (most common) and >70 years old - Men injured at least 2 times more than women
-Due to risky behavour
What is a central cord SCI?
-Rare type of incomplete SCI
Central Cord Injury: VERY rare, an individual with a central cord
injury does NOT have function to their upper body but HAS
function to their lower body! (neat)
High vs Low Paraplegia?
High: T2-T6
Low: T7 or below
What is a Axial Loading injury?
Axial loading – a lot of secodnay damage is caused from swelling on the spine
