Spinal Cord injury

Question 1

traumatic spinal cord injuries

most common in who?
most common cause?

Answer 1

• most common in young men

Causes:

• car accidents
• falls
• violence
• sports/recreation injuries
• alcohol
• disease
• work accidents
• risky behavior
• most injuries cause crushing, edema, hemorrhage or infarct

Question 2

what are the most common spinal segments that are injured with spinal cord injuries

Answer 2

• C4-C7 and T12-L2
• most mobility and least stability

Question 3

Common MOI for spinal cord injuries

Answer 3

• hyperflexion injury
• flexion-rotation injury
• hyperextension injury
• Vertical compression injury

Question 4

hyperflexion injuries

Answer 4

• head is pushed forward until chin is forced against chest
• fractures the bones at the front of the neck/back
• stretches/tears the ligaments
• can cause a cervical wedge fracture
• hitting the windshield when being hit from head on

Question 5

Flexion rotation injury

Answer 5

• can occur in both cervical and lumbar spine
• rear end collision with passenger rotated toward driver
• the head and body rotate in opposite directions severely twisting the ligaments, bones and spinal cord to the point where they may rupture, fracture or sever
• can cause anterior disolcation

Question 6

Hyperextension injury

Answer 6

• result of strong posterior force or falling with chin hitting a stationary object
• the head is forced back further than it can extend, fracturing the bones in the back of the neck and tearing the supporting ligaments in the front
• avulsion fracture can occur and rupture of the anterior longitudinal ligament

Question 7

Vertical compression

Answer 7

• the head is forced down into the shoulders with great pressure, compressing the spinal cord and possibly fracturing bones in the neck

Question 8

compression vs burst fracture

Answer 8

Compression:

• stable
• failure of anterior column without injury to middle column

Burst:

• unstable
• failure of both anterior and middle column
• often a boney fragment projecting into spinal canal

Question 9

Acute treatment of SCI

Answer 9

• stabilization of vital signs (sympathetic/parasympathetic regulation may be off)
• administration of anti-inflammatory drugs to limit swelling - inflammation that causes compression will make it worse
• stabilization/traction of spine
• repair and stabilization of fractures
• fusions, rods, plates
• external stabilization via Halo, SOMI, TLSO, jewitt etc.

Question 10

Halo immobilizer

Answer 10

• traction and stabilization
• lock pins into place
• typically used for hyperflexion/hyperextension

Question 11

SOMI

Answer 11

• Sterno-occipital-mandibular immobilizer
• can come off
• prevents flexion and rotation

Question 12

Jewitt brace

Answer 12

• prevents trunk flexion

Question 13

TLSO

Answer 13

• fitted supine
• must roll the patient into this
• goes around torso

Question 14

CASH brace

Answer 14

• prevents flexion and extension of T6-L1

Question 15

respiratory management

Answer 15

• cervical region
• diaphragmatic breathing
• use of ventilator
• glossopharyngeal breathing (frog breathing where air is forced into lungs)
• maximizing function

Question 16

Skin management for SCI

Answer 16

• bed and wheelchair positioning
• patient education
• high risk areas
• treatment of pressure ulcers

Question 17

Autonomic dysfunction with SCI

Answer 17

• most frequency in complete SCI above T6
• orthostatic hypotension
• poor thermoregulation
• autonomic dysreflexia

Question 18

autonmoic dysreflexia

Answer 18

• sympathetic: normal stimuli that wouldnt normally bother you does
• such as a full bladder

Question 19

Signs & symptoms side effects of autonomic dysreflexia

Answer 19

• hypertension: can be life threatening
• sweating above level of lesion
• flushed skin above level of lesion
• nasal congestion
• headaches
• blurry vision or seeing spots
• goose bumps
• only way to fix this is to get rid of stimulus

Question 20

causes of autonomic dysreflexia

Answer 20

• noxious or potentially noxious stimuli
• catheter tube kinked
• bladder distension
• UTI
• bowel impaction
• wheelchair or bed positioning causing pressure

Question 21

treatment of autonomic dysreflexia

Answer 21

• get patient upright to make orthostatic
• lossen any tight clothing or restrictive devices
• look for cause and correct it
• monitor BP and pulse
• emergency procedures
• contact nursing - catheterization PRN
• do not continue therapy
• pt may need medication to reduce BP - nitro
• monitor BP and symptoms for about 2 hours after episode

Question 22

Spinal shock

Answer 22

• occurs shortly after injury - last hours to weeks
• period of areflexia
• loss of sweating
• hypertension => hypotension
• flaccid paralysis below level of lesion
• complete or incomplete injury
• once this period is over there may be a different outcome for patient

Question 23

end of spinal shock period

Answer 23

• return of spinal reflexes
• stretch reflexes
• anal reflexes (sphincter function)
• hypertonia and spasticity below level of lesion may begin to develop as well as hyperreflexia

Question 24

Classification of SCI

Answer 24

• complete = lack of sensation/motor function at lowest sacral segment (S4-S5)
• incomplete = preservation of some sensation and or motor function including S4-S5

Question 25

SCI neurological level

Answer 25

• can vary for motor function and sensation
• can vary left to right
• can vary for motor function and sensation
• can vary from left to right
• lowest level where both sensory and motor function are normal
• zone of partial preservation
• determined by testing ASIA