Spinal

Question 1

What is neurogenic shock?

Answer 1

Will have cardiovascular effects
No balanced of Parasympathetic and sympathetic NS. PSNS takes over. This leads to bradycardia, hypotension, temp dysregulation.

Question 2

Tx for neurogenic shock

Goal for BP?

Answer 2

Vasopressors (usually norepinephrine (levophed) and fluids

Goal it to keep the MAP at 85–90

Question 3

What is anterior cord syndrome?

Answer 3

Incomplete spinal cord injury
Decreased blood flow to spinal cord from flexion injury

Motor paralysis

Keeps sensory except
Loss of pain/temp

Question 4

What is cauda equina syndrome?

Answer 4

Medical emergency!
Damage to lumbar/sacral nerve root

Patchy sensations in LE
Flaccidity in LE
No sensation in saddle area
Severe assymetric pain across dermatome

Question 5

What is central cord syndrome?

Answer 5

Damage to central cord, usually in cervical area from hyperextension injury.
Most common in elderly

Upper extremity only
No LE involvement
Weakness, altered sensation, pain

Question 6

What is brown sequard syndrome?

Answer 6

Damage to half spinal cord
Usually from penetrating injury

Contralateral: Loss of pain/temp
Ipsalateral: Loss of motor, light touch, pressure, position, vibration

Question 7

What is spina bifida?

Priority action at birth?

Answer 7

Incomplete closure of the neural tube
Happens at 4 weeks gestation
Unknown cause but theorize from low folic acid levels, genetic, or viral

Cover with moist, sterile dressing

Question 8

Three types of spina bifida?

Answer 8

Occulta: Dimple, tuft of hair. L5/S1 vertebrae don’t fuse

Meningocele: Sac containing CSF protrudes

Myelomeningocele: Worst type
Spinal cord and nerves protrude

Question 9

What other defects will commonly be present in spina bifida?

Answer 9

Club foot
Hydrocephalus
Flaccid legs
Incontinence

Question 10

What is trigeminal neuralgia?

RF?

Answer 10

Sudden brief recurrent excruciating usually unilateral PAIN along trigeminal nerve

Triggered by something like chewing, brushing teeth, talking, etc.

Caused by compression of nerve root

RF: Women, >50 yo

Question 11

Other s/sx of trigeminal neuralgia?

Answer 11

Facial twitching
Grimace
Blinking/tearing up
Stabbing shock waves of pain

Question 12

Tx of trigeminal neuralgia?

Answer 12

Pain meds don’t help

Electrical nerve stimulation
Nerve block
Antiseizure meds

Question 13

What is Bell’s palsy?

RF?

Answer 13

Acute temporary paresis unilaterally of face

Usually lasts 3–6 months

RF: Pregnancy, Obese, HTN, Diabetes

Question 14

Tx of Bell’s palsy?

Answer 14

Steroids
Antivirals (if virus present)
Moist heat
Electrical stimulation
Tape eye closed at night
Facial sling

Question 15

What is Guillain-Barre?

Tx?

Answer 15

Autoimmune ACUTE ONSET
After bacterial/viral infection
Demyelination starting at distal and working proximal to core.

Starts in feet»progresses up until it paralyzes diaphragm

Flaccid paralysis, symmetric weakness, rapid progression

Weakness, paresthesia, hypotonia are first signs

Tx: Supportive, IVIg, plasmapheresis

Question 16

What is Chronic inflammatory demyelinating polyneuropathy?
CIDP

Answer 16

Rare
GRADUAL onset, not acute like Guillain Barre

Similar to GBS in s/sx

Tx is same as GBS

Question 17

What is tetanus?

Answer 17

A bacterial infection that releases neurotoxins
Stops inhibitory neurotransmitters so it leads to muscle hyper RIGIDITY and SPASMS

Will have a precipitating event that exposed them to bacteria like:
Animal bite
Gardening injury
IV drug use
Rusty nail

Medical emergency
Given TIG (tetanus immune globulin)
Diazepam or barbiturates to control spasms
PCN to fight infection