Spinal Cord Injury

Question 1

What is a spinal cord injury?

Answer 1

major trauma to the vertebrae of the spine that causes nerve damage and prevents impulse transmission in the body.

severity is based on the sensory and motor loss associated with the injury.

Question 2

What are the 5 segments of the spine?

Answer 2

1. cervical (7)
2. thoracic (12)
3. lumbar (5)
4. sacral (5)
5. coccyx (4)

Question 3

What do the cervical nerves control?

Answer 3

• head, neck
• diaphragm, upper limbs.
• motor movement and sensory

Question 4

What do the thoracic nerves control?

Answer 4

• chest, abdominal and back muscles

Question 5

What do the lumbar nerves control?

Answer 5

• lower abdomen, back and lower limbs

Question 6

What do the sacral nerves control?

Answer 6

• bowels, bladder, buttocks, genitalia.
• lower limbs

Question 7

What do the coccyx nerves control?

Answer 7

• sensation of the skin on the lower back

Question 8

What is a primary injury?
What is a secondary injury?

Answer 8

Primary: sudden forceful injury thats distorts the spinal cord and causes damage.

Secondary: damage that occurs to the spinal cord as a result of neuro inflammatory responses.

Question 9

What happens to the spine with each of these?
- Hyperflexion
- Hyperextension
- Compression
- Rotational
- Transection

Answer 9

• Forward bending
• Backward bending
• force/pressure
• twisting
• seperation

Question 10

Who is at highest risk for spinal cord injury?

Answer 10

• men
• above age 40 increases risk
• toddlers and the elderly
• any person who participates in risky behaviors; motorcycles, ATV, diving, or sports without proper protection.

Question 11

What does the level of injury mean?

Answer 11

describes the vertical location of the injury along the vertebral column. (a specific area of the spinal cord/nerves that are damaged.)

• level of injury depends on the extent and type.
• ALL SYSTEMS BELOW THE LEVEL OF INJURY WILL BE AFFECTED.

Question 12

What are the emergency signs and symptoms?

Answer 12

• pain/pressure in the neck or back
• lack of sensation
• lack of bowel/bladder control
• impaired breathing
• old neck/back positioning

Question 13

What is spinal shock?
When does it occur?

Answer 13

a reversible loss of neurological functioning following an acute spinal cord injury. (reflex, motor, and sensory function) Occurs after injury and lasts from hours to weeks.

Question 14

Spinal Shock: Signs, Symptoms & Treatment?

Answer 14

S/S:
- hypotension
- flaccid paralysis
- urinary retention
- fecal incontinence
- sweating
- headache
- increased HR

Treatment:
- minimize stress
- inflammatory medications
- PT/OT
- maintaining healthy weights

Question 15

Complete vs Incomplete SCI

Answer 15

Complete; is a total loss of all sensory and motor function.
- IRREVERSIBLE

Incomplete; partial loss of sensory and motor function below the level of injury.
- better chance of recovery.

Question 16

What is a spinal concussion? What are the symptoms?

Answer 16

a mild injury or disturbance to the spine that causes varying degrees of sensory and motor impairment.

• back pain/pressure
• loss of bowel/urinary control
• weakness, lack of coordination
• numbness or tingling

Question 17

What is brown sequard syndrome?

Answer 17

Incomplete cord injury.
Hemiplegia - meaning one side of the body.

defined by the loss of motor function, movement and balance on the side of injury and a loss of sensory function, pain and temperature on the opposite side of the body/injury.

Question 18

What is autonomic dysreflexia?

Answer 18

an abrupt onset of excessively high blood pressure due to an overactive autonomic nervous system. (vasoconstriction)

• triggered by irritation or pain to the body, full bladder or bowel.

Question 19

What is the symptoms of autonomic dysreflexia?

Answer 19

S/S:
- flushing, sweating
- pounding headache
- bradycardia
- sudden HTN
- vision changes
- goosebumps
- seizures

Question 20

What is the treatment for autonomic dysreflexia?

Answer 20

Treatment is focused on fixing the problem that triggered it!
- postion changes
- treating for pain
- assess the body for anything putting pressure on it
- emptying the bladder and bowel
- removing tight clothing

Question 21

What are the mobility considerations for a patient with a SCI ?

Answer 21

• ADLs; eating, showering
• repositioning, Q2 turns
• range of motion
• PT/OT
• SCD/stockings
• ORTHOSTATIC HTN

Question 22

Coping & Emotional changes; how do we address the patient and their family ?

Answer 22

assist the patient/family through their loss and grief, encourage them to verbalize their feelings and concerns.
- encourage family participation.
- acceptance of the diagnosis leads to the best quality of life.

Question 23

What situations require emergency care? and what are the first two things you do ?

Answer 23

• unconscious
• head injuries
• MVA
• Falls
• penetrating injury

1. ABC’s!! Maintain the airway!! check the airway and ensure the patient is breathing.
2. Immobilize! stabilize the spine

Question 24

What are the pharmacological interventions?

Answer 24

• antibiotics for infection
• pain/nerve pain management
• anticoagulants for DVT prevention
• steroids for inflammation

Question 25

Considerations for cervical traction:

Answer 25

do not move or change the free hanging weights

if it becomes dislodged immediately stabilize the spine and call the HCP.

Question 26

Considerations for the Halo device:

Answer 26

never lift or grab the patient by the fixator

always keep the wrench with the patient

only clean the pins with normal saline and then apply antibiotic ointment.

if dislodge immediately immobilize the head/neck with rolled towns and call HCP.