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Flashcards in SPI Deck (26):
1

Classification of SPI

Complete and incomplete

2

Complete Spinal

Damage eliminates all nerve innervation below the level of injury

3

Incomplete Spinal

Still allows some fx or movement below the area of injury

4

Types of Trauma/ Injury

Primary and secondary

5

Primary Injury

Hyperflexion
Hyperextension
Axial loading or cord compression
Excessive Rotation
Penetrating trauma

6

Excessive Rotation

Rotation of head beyond normal range

7

Hyperflexion

Head forcefully accelerated forward causing extreme neck flexion

8

Hyperextension

head forcefully accelerated back then decelerates

9

Axial loading or cord compression

excessive force drives wt of body against head and causes compression of spinal cord

10

Secondary SPI

Hemorrhage
Ischemia
Neurogenic shock
Spinal shock

11

C1- C3

Needs ventilator support to survive

12

C4

No control of arms

13

C5-C6

Some movement of arms

14

C7

possible to transfer self independently

15

C8

Movement of fingers along with arms; able to do more complex skills

16

Secondary Injury: Cord Edema

Injury causes microscopic bleeding and inflammatory rx
peaks in 2-3 days , subsides around 7 days
Edema often extends to - 2 cord segments above and below site of injury
Difficult to determine degree of impairment

17

Secondary Injury: Spinal Shock

Complete, but temporary loss of motor fx, sensory, reflex and autonomic fx below level of injury
Results in flaccid paralysis, no refelxes (bladder bowel)
May last a few days.. or weeks
Return to reflexes indicates that spinal shock is resolving
Absence of ALL voluntary and reflex neurologic activity below level of injury
> v reflexes
> loss of sensation
> flaccid paralysis below injury

18

Secondary Injury: Neurogenic Shock

Loss of Sympathetic vascular tone = v sympathetic impulses to blood vessel smooth muscle and results in peripheral dilation and pooling of peripheral blood.

Hypotension
Bradycardia
Unstable temp
occurs within 30 min cord injury at level T5 or above and lasts up to 6 wks

19

Management of Neurogenic shock

Airway support
iv fluids NS
Atropine for bradycardia
Vasopressors: norepinephrine
Keep Map above 80-85, adequate UOP
Supine position
Active warming as needed

20

Pre-hosptial care

#1 thing:cervical collar
Remember ABCs
C4 and above needs ventilator support
Jaw Thrust, not head tilt

Criteria for spinal immobilization
-MOI
-spinal tenderness, AMs, LOC, neuro deficit, and intoxication

Recognize potential for other injuries
- Head, chest, abdominal, extremity injuries

21

ER care

-Spinal x-rays (neck down)
- CT head/spine
-MRI to visualize cord

LABS
ABG, CBC, CMP
Serial H/H if potential blood loss (q 4 or 8)

22

Initial TX

Cervical
-maintain spinal precaustions
-cervical neck collar
-log rolling
-halo INSPECT PIN SITES FOR INFECTION
Thoracic/ Lumbar
-Thoracic TLSO (made for their bodies)

23

SCI TX

Prevent pressure sores
-may not feel pain
-repostion

Paralytic illeus
antiemtics
NG tube PRN

24

Beyond the ED

Admit to ICU or SC unit

ongoing management
-ventilator > trach prn
-be alert for decreased rest fx as more proximal spinal segments are affected as edema worsens
-Prevent aspiration, atelectasis, pneumonia

onging management of spinal shock

25

Surgical management

Stabilization
-fusion of vertebra
-insertion of rods or other fixation
Decompression of cord
-removal of fluid, tissue, bone fragments

26

Methylprednisone

Steroid
Bolus given iV within first 8 hr of injury, followed by drip for first 24 hrs to decrease initial inflammatory process

decrease inflame because suppressed immune system