Spinal Cord injury

Question 1

what is the cause for most spinal cord injuries?

Answer 1

motor vehicle collisions
falls
violence
sports injuries

Question 2

there are two types of injury when it comes to injury to the spinal cord, what are they ?

Answer 2

primary and secondary

Question 3

what is primary injury?
what is secondary injury?

Answer 3

primary
- direct trauma from blunt or penetrating trauma

secondary
- ongoing, progressive damage that occurs after primary injury

Question 4

in the secondary injury, what are the 3 symptoms that patients often will experience that will cause their treatment of a spinal cord injury take longer?

Answer 4

edema - within 24 hours after injury

ischemia
inflammation
- nerve damage

Question 5

so if we dont treat that prolong ischemia, the lack of oxygen reaching the body, the body will release epiphenrine and noepinephrine. when these two release, _____happens and leads into what condition?

Answer 5

vasoconstriction

autonomic dysreflexia

Question 6

there 3 types of spinal cord injuries

cervical injury
thoracic injury
lumbar injury

explain to me what each site of injury will a patient end up showing. like what is the paralysis state of it ?

Answer 6

cervical
- 4 limbs paralyzed
- breathing is massive problem here

thoracic
- parapalegic
- legs and pelvic organs

lumbar injury
- legs and leaky bladder

Question 7

what 2 types of shock can a patient experience with a spinal cord injury?

Answer 7

spinal shock
neurogenic (vasogenic) shock

Question 8

when does a spinal shock occur?
and what are the symptoms often associated with it ?(3)

when in recovery from spinal shock, that can happen that we need to educate patients on ?

Answer 8

occurs shortly after injury and lasts days to weeks

• loss of senstations
• loss of deep tendon reflexes
• flaccid paralysis below level of injury

hyperreflexia
- does not indicate mobility has returned

Question 9

when does neurogenic shock occur?

what are the 3 signs and symptonms associated with it?

Answer 9

occurs in injuries above T6

hypotension
bradycardia
polikthermia

Question 10

the degree of a spinal cord injury really depends wheather if it was complex or partial. describe what each of these mean

and what is better

Answer 10

partial is better since you have some loss of movement and retain some paralysis

complete, you have loss total sensory and motor function below level of injury

Question 11

what is the scale that we use to major the impairment of a patient with a spinal cord injury ?

Answer 11

american spinal injury association impairment scale (asia)

Question 12

what are the diagnostic studies that we use to help confirm a spinal cord injury?

Answer 12

ct scan

Question 13

a patient comes into the hospital with a spinal cord injury , what is the interprofessional care that we perform in an emergency setting?

Answer 13

• patent airway
• adminitser o2
• maintain sbp 90
• iv access
• monitor neurogenic shock
• immobilize and stabilize
• assess for other injuries
• control external bleeding
• obtain appropriate imaging
• keep warm
• vital signs

Question 14

if we plan to move a patient with a spinal cord injury, what is the way we are going to move them?

Answer 14

logroll

Question 15

what tool are we first going to use to help stabilize the injury ?

Answer 15

usually a traction for the mean time before having a full assessment be done

Question 16

usually in acute settings, traction is used to help stablilze, but we also can do surgery, however it must be done within ____

Answer 16

24 hours

Question 17

what are the drugs and treatments we are going to give a patient with neurogenic shock? (2)

Answer 17

iv fluids - vaso pressers
vte prophylaxis ( heparin )

Question 18

in a high cervical spinal cord injury, what is the tool that we use to immboilize the head?

Answer 18

halo vest

Question 19

what is the biggest risk factor that we have when it comes for a patient wearing a halo vest?

Answer 19

infection

Question 20

what are we doing to use to clean the pins that are attached to your skull and connected to the vest to help stablize the neck?

Answer 20

chlorhexidine

Question 21

the best advantage behind a halo vest is what?

Answer 21

allows for movement to occur while bones are fusing back into place

Question 22

what is the main condition or how often do we see autnomic dysreflexia occur in which type of injury ?

Answer 22

above t-6

Question 23

why is autonomic dysreflexia a deadly condition ?

Answer 23

extreme hypertension can lead to status epilepticus, stroke, mi or even death

Question 24

what are the 4 causes of autonomic dysreflexia?

Answer 24

restrictive clothing
pressure areas
full bladder/uti
fecal impaction

Question 25

some notes to notice is that if im taking a test and they use when talking about spinal cord injuries above t6 typically full bladder or distended bladder constipation tight clothing this is a massive warning for what?

Answer 25

autonomic dysreflexia

Question 26

what is the patho behind autonomic dysreflexia? - according to the simple nursing video

Answer 26

so typically we have sns, which helps vasoconstrict to help increase our blood pressure and we have pns, which helps vasodilate to help lower our blood pressure. in a normal person these work together to equalize the blood pressure however in a spinal cord injury - they are unable to communicate, so above the level of injury we have vasodilate and below the injury, vasoconstriction - resulting in a tug-war since sns and pns are mis communicating

Question 27

what are the 6 signs and symptoms of autonomic dysreflexia?

Answer 27

1. sweating (diaphoresis) 2. severe hypertension 3. flushing 4. headache 5. bradycardia 6. distended neck veins

Question 28

what are the interventions, or step by step assessment for a patient with a spinal cord injury ? (6 steps)

Answer 28

1. elevate hob 45/sit up 2. assess and remove cause ( palpate bladder, ask bowel movement immediate cath, remove stool, remove clothing) 3. call provider 4. check blood pressure 5. bp meds after assessment 6. educate

Question 29

if a patient is having an headache in autonomic dysreflexia, do we give medications for it why or why not?

Answer 29

no!! remember its being caused by obstruction of bladder, bowel or clothing so if we treat that, the headache should resolve