Exam 2: Spinal Cord Injury

Question 1

What is the most common area of injury?

Answer 1

C5

Question 2

What are the 2 types of SCI?

Answer 2

Complete → damage that eliminated all innervation below injury

Incomplete → injury allows some function below injury

Question 3

Which type of SCI is more common?

Answer 3

Incomplete

Question 4

What are the two causes of SCI (very general terms)

Answer 4

Primary → initial injury
Secondary → effect after initial injury that worsens the primary injury

Question 5

Describe what is happening with hyperflexion (this is PRIMARY).

Answer 5

Head comes forward

Question 6

Describe what is happening with hyperextension (this is PRIMARY).

Answer 6

Head goes backwards

Question 7

Describe what is happening with axial loading / vertical compression (this is PRIMARY).

Answer 7

Pushed down (football players get this a lot)

Question 8

Describe what is happening with excessive rotation (this is PRIMARY).

Answer 8

Twisting

Question 9

Describe what is happening with penetrating trauma (this is PRIMARY).

Answer 9

It’s a penetrating trauma.
Ex: Nails in back

YIKES

Question 10

Describe what is happening with distraction (this is PRIMARY).

Answer 10

Pulling away from neck (up)

Ex: Hanging

Question 11

What are some examples of secondary causes of SCI?

Answer 11

• Hemorrhage
• Ischemia
• Hypovolemia
• Impaired tissue perfusion
• Edema

Question 12

The higher up injury = the more ________ symptoms.

Answer 12

Severe

Question 13

You see CV issues when the injury is above ___.

What issues do you see?

Answer 13

Above T6
→ Bradycardia
→ Hypotension
→ Dysrhythmias

Question 14

When the injury is ____ you see respiratory issues.

Answer 14

Cervical
“C3, C4 breathe no more”

Question 15

What are dermatomes?

Answer 15

Zones of sensory motor function
→ Utilized as part of assessment

Question 16

What are myotones?

Answer 16

Zones of muscle function

Question 17

Plegia =

Answer 17

Paralysis

Question 18

Tetraplegia / quadriplegia =

Answer 18

Complete paralysis of all 4 extremities

Question 19

Paraplegia =

Answer 19

Lower extremity paralysis

Question 20

Paresis =

Answer 20

Weakness

Question 21

Quadriparesis =

Answer 21

Weakness in all 4 limbs

Question 22

Paraparesis =

Answer 22

Weakness in lower extremities

Question 23

Talk to me about spinal shock.

Answer 23

→ Occurs immediately after injury
→ Not a real “shock”
→ Has temp complete loss of motor sensory reflex and autonomic function
→ Lasts ~48 hrs, can last weeks
→ Typically occurs within 24 hours of injury, lasting up to weeks
→ Loss of spinal cord function below level of injury

Question 24

Respiratory compromise occurs due to innervation of the _________ __________ (controls diaphragm).

Answer 24

Phrenic nerve

(Remember: Respiratory compromise = cervical injuries at C3-C5)

Question 25

What is the quad cough?

Answer 25

→ If they can’t cough and suctioning is not adequate, take hands and when then breath out, PUSH (below xiphoid) → Can implant pacemaker there to stimulate diaphragmatic contractions

Question 26

What is autonomic dysreflexia?

Answer 26

(aka autonomic HYPERreflexia) → Life threatening → Noxious stimuli causes change in SYMPATHETIC NS → Below the level of injury → → Full bladder / UTI, bowel distension, impaction, constipation → → Circumferential compression - thorax, abd, scrotum, or extremities (tight clothing) → Temp → Pain / pressure

Question 27

Name some symptoms you might see with autonomic dysreflexia (there are a bunch):

Answer 27

→ Sudden increase in systolic and diastolic BP → Bradycardia -- reflexive bradycardia, body is trying to normalize. Due to increasing BP, might be tachy first → Severe HA → Nasal congestion → Diaphoresis (above injury) cold or goose bumps below → Flushed skin above the injury → Pale, goosebumps below the injury → Vasodilation above, vasoconstriction below

Question 28

What are some diagnostics used with SCIs?

Answer 28

→ Dermatomes → X-ray (Identify fractures, subluxation, dislocation) → Spinal CT → MRI (CT and MRI can determine degree and extent of damage)

Question 29

Re: Treatment for SCIs. What is something that we do that is non-surgical? Tell me a little about it.

Answer 29

Spinal cord stabilization dislocation) → To maintain cervical alignment dislocation) → Cervical collar dislocation) → Halo dislocation) → Skeletal traction (Realign vert, facilitate bone healing, prevent further injury) dislocation) → Use “Log roll” -- You should have 4 people!

Question 30

What are some skeletal muscle relaxants used in SCIs (3)?

Answer 30

→Tizanidine → Cyclobenzaprine → Baclofen

Question 31

What is some shit that they might do in surgery with a SCI?

Answer 31

→ May remove bone fragments, hematoma, penetrating objs → Wiring , insertion or rods, spinal fusion

Question 32

Other meds used in SCIs?

Answer 32

Intrathecal baclofen → Given right at site of spinal cord injury Steroids Pain management → Gabapentin → Lyrica → NSAIDS BP meds Stool softeners

Question 33

What kind of mattress do we want with SCIs?

Answer 33

FIRM. None of that specialty air mattress shit.

Question 34

Talk me through a log roll with a spinal cord patient.

Answer 34

Turn pt w/o moving spine → Spine is to remain straight when getting out of bed → Should have 4 people → Person who has airway/c-spine calls when to start

Question 35

What does BLT (mnemonic for SCI patients) stand for?

Answer 35

→ Bending - Avoid it. Bend at hips. → Lifting - No more than 5-10 lbs → Twisting - Nope. Shuffle and turn to look at something