- Vascular damage (AVM, hemorrhage) - Occupying space (neoplasm, abscess, syrinx) - Secondary damage (MS, ALS) - infection (transverse Myelitis) - compression (DJD)

- incomplete tetraplegia: 47% (C5-C7) - incomplete paraplegia: 20% (T12-L2) - complete paraplegia: 20% - complete tetraplegia: 12%

- decreased life expectancy - mortality rate highest in the first year

- Ensure optimal ventilation and circulation - Physical exam, neurological exam, imaging (CT, MRI)

- Check to see if ventilation is - Organ function - Ensure proper circulation (avoid hypoxia and hypotension) - Bowel/bladder management (catheters inserted) - Integumentary integrity

- Used in surgical and nonsurgical interventions - Halo (good at preventing cervical rotation) - spinal orthodox - recumbent positioning - monitor skin integrity

- Transient reflects depression (abrupt loss of connection between cortex and spinal cord) - Areflexia - Loss of reflexes = bulbocavernosus, cremasteric, babinski - impaired regulation of hormones: hypotension, lack of piloerrection, no sweating - Can last 24 hours - It’s slowly regained after 72 hours up to four weeks - Do not assess spinal cord level until after 72 hours

- UMN injury (common in cervical SCI) - Spasticity, high muscle tone, clonus, muscle spasms, hyperactive reflexes - Gradually increases during the first six months, plateaus after year one

SCI (Part 1) Flashcards by JALEEL GREEN

Traumatic SCI

Mechanical forces (non-reversible damage)

- Secondary microvascular, biomechanical, cellular processes (apoptosis, edema, information)

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Non-traumatic SCI

Vascular damage (AVM, hemorrhage)
Occupying space (neoplasm, abscess, syrinx)
Secondary damage (MS, ALS)
infection (transverse Myelitis)
compression (DJD)

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% break down of SCI

incomplete tetraplegia: 47% (C5-C7)
incomplete paraplegia: 20% (T12-L2)
complete paraplegia: 20%
complete tetraplegia: 12%

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SCI: Prognosis

decreased life expectancy

- mortality rate highest in the first year

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Causes of Death for SCI

pneumonia

- sepsis (urinary infection, pressure ulcers)

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SCI: Initial Management

ABC (airway, breathing, circulation)
management of life threatening injuries
It might be in SCI if there is… (Paresthesia, spinal pain, sensory loss, altered mental state)
Stabilize or immobilize the spine (no A/PROM, backboard, c-collar)
transport to trauma center

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SCI: Trauma Center

Ensure optimal ventilation and circulation

- Physical exam, neurological exam, imaging (CT, MRI)

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SCI: ICU Management

Check to see if ventilation is
Organ function
Ensure proper circulation (avoid hypoxia and hypotension)
Bowel/bladder management (catheters inserted)
Integumentary integrity

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SCI: High Dose Steriods

no evidence to support use

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SCI: Local and Systemic Hypothermia

Goal = minimize secondary damage and no protection
- Reducing cell death, oxidative stress, information, Adema, and minimize secondary
  ischemia

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SCI: Fracture Management

Facture stabilization (open reduction)
- Unstable fracture site, cord compression, malalignment, deteriorating neuro status)
performed with 24hrs of injury

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SCI: Non-surgical Intervention

Closed reduction
Traction devices (fracture/dislocation, cervical subluxation)
Immobilization (positioned in a rotating bed)

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SCI: Immobilization

Used in surgical and nonsurgical interventions
Halo (good at preventing cervical rotation)
spinal orthodox
recumbent positioning
monitor skin integrity

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Spinal Shock

Transient reflects depression (abrupt loss of connection between cortex and spinal cord)
Areflexia
- Loss of reflexes = bulbocavernosus, cremasteric, babinski
- impaired regulation of hormones: hypotension, lack of piloerrection, no sweating
- Can last 24 hours
- It’s slowly regained after 72 hours up to four weeks
Do not assess spinal cord level until after 72 hours

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Hypertonia

UMN injury (common in cervical SCI)
Spasticity, high muscle tone, clonus, muscle spasms, hyperactive reflexes
Gradually increases during the first six months, plateaus after year one

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Hypertonia Management

Stretching
Surgery
Medication
- oral: (mm relaxants and spasmolytic agents: baclofen, tizandine, diazepam, dantrolene sodium)
- botulinum neurotoxin intramuscular injection
- baclofen pump: intrathecal

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Autonomic Dysfunction: Cardiovascular Impairments

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Parasympathetic (Vagus n.) (vasodilation, slows HR)
Sympathetic nervous system (T1 to L2)
- Cardiac function is innervated above T6
C7 injuries implications
- Only have parasympathetic to the heart
T10 injury implications
- Have parasympathetic and sympathetic intact
- less complications due to imbalance of sympathetic and parasympathetic

SCI: Orthostatic Hypotension

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most severe in above T6 injuries
unopposed parasympathetic, and impaired sympathetic to the heart —> bradycardia and vasodilation of peripherals
decreased muscle activation —> pooling in peripheral limbs
pro-longed bed rest —> deconditioning
sx: dizziness, blurred vision, headache

SCI: Orthostatic Hypotension Management

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gradual progression of upright tolerance (head of bed —> recliner w/c —> standing frame/tilt table)
abdominal binder
compression stocking
medication
as vasomotor stabilizes, sx decrease

Cardiovascular Presentation during Tx Sessions

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tetra (decreased peak HR, post exercise hypotension, abnormal response to exercise)
Para (reduced exercise tolerance, stroke volume, cardiac output)

Impaired Temperature Control

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depends on level and completeness of injury
inability to regulate cutaneous blood flow or sweating
may result in hypo- and/or hyperthermia

Autonomic Dysreflexia

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typically occurs in patients with chronic, complete, above T6 SCI
noxious stimuli below level of in injury —> afferent input to SC —> overactive sympathetic activity (mass reflex response) —> increase BP —> (over active parasympathetic above injury level above level of injury
- common causes: bowel, bladder, painful stimuli
if not address: seizure, cardia arrest, SAH, stroke, or even death
- because the BP on keep on increasing

Autonomic Dysreflexia: symptoms

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HTN
Bradycardia
profuse sweating above LOI
vasodilation (flushing) above LOI
vasoconstriction below level of injury
increased spasticity
headache
constricted pupils, blurred vision, nasal congestion, pilo-errection

Autonomic Dysreflexia: Management

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upright position
remove noxious stimuli
- bladder distention/ catheter kink
- tight clothes
- pressure sore
- possible bowl impaction
monitor vitals
seek medical attention
education

Pulmonary Impairments

- depends on the level of injury - more rostral = more impairment - rib fx - other comorbidities (like COPD) - pulmonary complications are the leading cause of death in early and late stages of recovery

Pulmonary Impairment: C1-C2

- only accessory muscles are innervated - ventilator is needed to breathe - passive expiration: airway clearance required

Pulmonary Impairment: C3-C4

- partial diaphragm, partial scalenes, lev scap - ventilator needed for acute (maybe be able to ween off) - passive expiration: airway clearance required

Pulmonary Impairment: C5-C8

- full diaphragm, partial pec, serratus anterior - no ventilator required - forceful cough is severely impaired (no abdominal mm)

Pulmonary Impairment: T1-T5

- intercostal mm (T1-T11) | - posterior serratus (T1-T3)

Pulmonary Impairment: T6-T10

- abdominal (T6-L1) | - Intercostals (T1-T11)

Pulmonary Impairment: T1 and below

- lack QL, and full abdominals

Pulmonary Impairment:Ventilator

- endotracheal intubation - tracheostomy (allows speaking and eating; speaking during expiration) - portable units - phrenic n. stimulator (help reduce need of ventilator) - diaphragmatic pacer - emergency response (ambuBag)

Pulmonary Impairment: Forced expiration

- secretion management - coughalator - suctioning

Pulmonary Impairment: Respiratory Function

- vital capacity = the max amount of air that can be push out after the deepest breathe possible - <25% of normal in cervical injuries - 70-80% of normal in TS injuries

Pulmonary Impairement: functional cough

- 2 coughs with 1 exhalation - weak: 1 cough with 1 exhalation - nonfunctional: no explosive force (clearing throat)

Bowel/bladder/and sexual dysfunction

- UMN (spastic/reflexive/neurogenic) - bladder contracts reflexively with filling pressure - LMN (arreflexive/flaccid) - bladder can not contract on reflex - leads to failure to store urine or failure to release

Pain: musculoskeletal

- over use (UE, shoulders) - poor posture/ body mechanics - muscle imbalance

Pain: Neuropathic

- can occur at or below the level of injury - injury to the SC or nerve root - can be central (allodynia and hyperalgesia) - diffuse - above the level of injury (peripheral pain) - difficult to manage (tens, massage, mental imagery, pharmacology)

Secondary Implication: Integumentary

- pressure ulcers - leading cause of death - infection is leading cause of death (UTI, pneumonia, pressure sore)

Secondary Implication: Pressure Ulcer: Risk Factors associated with it

- tetra - incontinence - spasticity - nutrient deficiency - decreased mobility for self care - smoking - poor compliance with skin care - immobilized for long durations

Secondary Implication: Pressure Ulcer Prevention

- minimize staying in one position - weight shifting to allow adequate blood flow to the area - bed (every 2 hours, pressure relieving bed) - wheelchairs (every 15-30 min for 2 minutes)

SCI (Part 1) Flashcards

(41 cards)