SCI Acute Care

Question 1

What is the goal of early surgical decompression?

Answer 1

Improve blood flow and decrease the expansion of the zone of secondary injury

Question 2

What is early surgical decompression associated with?

Answer 2

Decreased medical complications and decreased hospital stay

Question 3

What is the prognosis of early surgical decompression?

Answer 3

Patients are 2.8x times more likely to improve 2 AIS grades 6 months after injury if early surgical decompression is performed less than 24 hours after injury

Question 4

What is the goal of methylprednisolone?

Answer 4

Upregulation of anti-inflammatory cytokine release and decreased oxidative stress

Question 5

Why is methylprednisolone controversial?

Answer 5

It resulted in an increase in sepsis and pneumonia when given for 48 hours after injury in the past.

Question 6

What is the current recommendation for the administration of methylprednisolone?

Answer 6

Given between 8 hours and 24 hours after injury

Question 7

What is methylprednisolone associated with?

Answer 7

Improvement of 4 motor points on the ASIA exam and fewer medical complications

Question 8

What are the primary respiratory goals?

Answer 8

Improves ventilation
Increased effectiveness of cough
Prevention of chest tightness
Prevent ineffective substitute breathing patterns

Question 9

What does respiratory management consist of?

Answer 9

Diaphragmatic breathing
Diaphragm PREs
Productive cough
Assisted coughing
Abdominal binder

Question 10

Steps of medical management of acute injury

Answer 10

Immobilization at scene of accident
Maintain systolic BP greater than or equal to 90 mmHg for 7 days after injury
Once stabilized, ASIA exam to determine level of injury and completeness
CT scan. MRI as well if mechanism is unexplained
Transport to specialty center if SCI is established

Question 11

How does one immobilize the patient at the scene of the accident?

Answer 11

With stiff cervical collar and supportive blocks on a backboard

Question 12

What is maintaining BP greater than or equal to 90 mmHg for 7 days after injury associated with?

Answer 12

Improved AIS outcomes

Question 13

Motto for early surgical decompression?

Answer 13

Time is spine

Question 14

What are harrington rods typically used for?

Answer 14

Scoliosis

Question 15

What is used for surgical spine stabilization?

Answer 15

Bone graft and/or hardware and orthosis

Question 16

Difference between Minerva and SOMI braces compared to Gardner-Wells tongs and Halos

Answer 16

Minerva and SOMI braces are used for less severe cases that need immobilization but not as much traction

Question 17

What are the 3 thoracic and lumbar stabilizers discussed in class?

Answer 17

Jewett Brace
Custom TLSO
Knight-Taylor Brace

Question 18

What are the 3 points of support on the thoracic and lumbar stabilizers?

Answer 18

Sternum
Pubic symphysis
Back

Question 19

What is the most stable of all the thoracic and lumbar stabilizers discussed in class?

Answer 19

Custom TLSO

Question 20

How often should patients with SCI learn to change positions when laying down?

Answer 20

Every 2 hours

Question 21

How many positions do patients with SCI have to switch through in order to prevent skin breakdown?

Answer 21

3-5 positions

Question 22

What positions do patients with SCI switch through in order to prevent skin breakdown?

Answer 22

Supine, 30-45 deg R+L, side-lying R+L

Question 23

What does the chest do during normal inspiration?

Answer 23

Elevates and expands

Question 24

What does the abdomen do during normal inspiration?

Answer 24

Distends

Question 25

What does the chest do during normal expiration?

Answer 25

Drops and contracts

Question 26

What does the abdomen do during normal expiration?

Answer 26

Caves

Question 27

Exercises for deep breathing

Answer 27

Manually resisted inspiration and expiration | Incentive spirometry from HEP

Question 28

Coughing technique

Answer 28

Take deep breath Turn head, cough twice Expel secretions on second cough

Question 29

Assisted cough technique

Answer 29

Place hands over diaphragm with fingers interlocked and elbows straight Push/scoop up (timed correctly with patient) Avoid ribs and xiphoid

Question 30

What are 2 ways the patient can assist themselves when coughing?

Answer 30

Self-assist with wrists or pillow

Question 31

What are the instructions for the patient to self-assist when coughing?

Answer 31

Sit erect in w/c Place both wrists in abdomen or pillow on lap Take deep breath Throw yourself onto wrists while pulling up and in while coughing (For pillow, just throw self onto pillow)

Question 32

When should orientation to vertical be introduced?

Answer 32

After radiographic union and MD clearance

Question 33

Why use tilt table?

Answer 33

Because the patient might be on restrictions after their spinal surgeries and they may not be able to flex their legs enough to get themselves into the seated position

Question 34

How do you implement the tilt table?

Answer 34

Gradually progress to prevent OH. Do not exceed 70 deg tilt

Question 35

Why encourage good posture during w/c sitting?

Answer 35

To prevent malalignment and to put the body in optimal position for efficient breathing

Question 36

What is another reason to encourage good posture for patients with high SCI with no trunk control?

Answer 36

To prevent the trunk extensors and ligaments in the lower back from shortening when the patients body is in an elongated position. When they shorten in a shortened trunk position, it provides the patient with a mechanical advantage to be able to do bed mobility and transfers

Question 37

What can cause sacral-sitting?

Answer 37

Sling seats and sling back on w/c

Question 38

Pressure relief starts with...

Answer 38

w/c cushion

Question 39

How often should pressure relief be done?

Answer 39

10 seconds every 10-15 mins

Question 40

2 ways in which someone with paraplegia or low quadriplegia can perform pressure relief

Answer 40

Push-up with hands on arm rest, wheels, or push rims | Wheelie resting position

Question 41

What is a tool necessary for skin inspection?

Answer 41

Long handled mirror

Question 42

Where should a patient with SCI inspect their skin?

Answer 42

At sacrum and coccyx Ischial tubes Heels

Question 43

What are the general principles of progression of treatment activities?

Answer 43

``` Assume the position Maintain the position Weight shift in position Transition into and out of the position Move from one position to another in the position ```