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Medpsych: Test 4 > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

(93 cards)

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1
Q

what is the fx of the vertebrae?

A

provide bony support while still allowing mobility

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2
Q

what makes up the gray matter of the spinal cord?

A

Anterior horns- motor relay pathways

Posterior horns- sensory relay pathways

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3
Q

what makes up the white matter of the spinal cord?

A

Corticospinal tract: voluntary motor
Spinothalamic tract: pain sensation
Posterior columns: touch sensation

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4
Q

what can cause injury to spinal cord?

A

issues with blood supply to cord

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5
Q

why is it important to differentiate where in the sacral region injury occurred?

A

it determines bladder, bowel and sexual function/dysfunction

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6
Q

what does Injury to UMN destroy?

A

destroys cerebral influences or control over LMN (called UMNL- upper motor neuron lesion)

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7
Q

what does Injury to UMN result in?

A

spasticity (spastic paralysis)- loss of coordinated and integrated cerebral control over all reflex activity below level of injury

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8
Q

What does injury to LMN result in?

A

flaccid paralysis- destruction of the reflex arc breaks connection to intact UMN

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9
Q

what is the average age for SCI?

A

16-30

19 most freq

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10
Q

what does life expectancy depend on?

A 
age at injury (and/or how long ago they were injured)
Other complications (secondary issues)
Severity of injury
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11
Q

what is the term for 4 limbs paralyzed? 2 limbs?

A

Tetraplegia

paraplegia

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12
Q

what are the causes for traumatic SCI?

A

MVA- most frequent- 37%
Falls
Violence
Sports injuries (most diving)

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13
Q

how does cancer cause a non traumatic SCI?

A

tumor within cord or in spinal canal pressing on cord

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14
Q

how does blood supply cause a non traumatic SCI?

A

Bleed from vessel into canal which takes up space + compresses spinal cord –> no blood supply
Occlusion of blood flow into cord i.e. due to blood clot or crush injury

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15
Q

what is a simple fracture of the vertebral column?

A

usually neural arch without injury to the spinal cord

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16
Q

what is a Compression or Wedge Fracture?

A

anterior compression injury to the vertebral body

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17
Q

what is a Comminuted or Burst Fracture?

A

shattering injury to the vertebral body;

fragments impinge on spinal cord; result in severe damage

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18
Q

what is a Teardrop Fracture?

A

small fragment chipped from vertebra;
lodges in spinal canal
associated with posterior dislocation of vertebral body

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19
Q

what is Dislocation/subluxation

of the vertebral column?

A

Vertebral bodies become displaced and can cause traction

Subluxation = partial dislocation

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20
Q

what is a Fracture/dislocation

of the vertebral column?

A

Describes a fracture and dislocation often associated with ligamentous and cord injury

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21
Q

what is the extent of a spinal cord injury based on?

A

Amount of force (how hard did injury take place)
Direction of force
Rate of application of the force

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22
Q

what is a flexion injury of the spine?

A

Forward bending that exceeds normal bending

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23
Q

what is the point of impact for a flexion injury?

A

Back of head

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24
Q

what is hyperflexion?

A

whiplash

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25
what is the point of impact for an extension injury?
chin or face
26
what can cause a compression injury?
Spinal loading from blow to top of head or landing hard on your feet when vertebrae are weakened by conditions like osteoporosis and cancer with bone metastasis
27
what level of the spinal cord does compression injury occur?
cervical level or thoracolumbar area
28
what is a axial-rotation injury?
Twisting tears fibers of spinal cord | causing very unstable injury
29
at what level of the spinal cord does axial rotation injury occur?
lumbosacral joint and at C1-C2 joint | Stability of sacrum with lots of movement on top
30
what can cause a penetrating injury?
gunshot, stab | burst or teardrop fracture where bone lodges itself in cord tissue
31
what can penetrating injury result in?
cord injury without vertebra (bone) injury and vice versa
32
what is a coupling injury?
multiple mechanisms for injury such as compression or traction with flexion/extension (more mechanisms = more complication)
33
what occurs during a primary injury?
occurs at the time of the mechanical injury small hemorrhage in gray matter followed by edema in white matter causing necrosis
34
what types of injury do primary injury involve?
compression, stretch, shear, and contusion
35
what does laceration cause?
primary injury to the cord with associated bleeding and edema
36
what is secondary injury?
increase the spread of injury, pathology that occurs following injury
37
what does secondary injury cause?
vascular- vessel trauma and hemorrhage; can lead to ischemia and edema neural- loss of spinal reflexes below level of injury resulting in spinal shock, vaso spasm and further inhibit blood flow, increasing necrosis
38
how do you prevent further damage in secondary injury?
Anti-inflammatory medication | Open up space in vertebral canal so swelling has room to occur
39
what is an unstable injury?
when vertebral and ligamentous structure not able to support or protect injured area Stability needs to be provided in order to heal
40
what determines a stable injury?
alignment and strength is maintained | No soft tissue damage and musculoskeletal system is intact
41
what is tetraplegia?
impairment or loss of motor and/or sensory function in the cervical segments of the cord due to damage of neural elements within the spinal canal
42
what does tetraplegia result in?
impairment of function in arms trunk, legs and pelvic organs (4 limbs)
43
what does tetraplegia not include?
peripheral nerve injuries
44
what is paraplegia?
impairment or loss of motor and/or sensory fx in thoracic, lumbar, or sacral (NOT Cervical) segments of spinal cord
45
what injured parts of spinal cord does paraplegia include? what does it not include?
conus medullaris and cauda equina injuries at tip of spinal cord NOT peripheral nerves outside the spinal canal
46
what is complete SCI?
complete loss of all motor and sensory nerve transmission to areas below level of injury
47
what are the causes of complete SCI?
complete severance of cord complete breakage of nerve fibers by stretching of the cord (coverings could be intact and cord may look normal) complete ischemia of cord by interruption of total blood supply Can have incomplete injury with lacerations not complete
48
what is incomplete SCI?
partial laceration or necrosis of spinal cord | Some info can get back and forth
49
What does the neurological assessment of SCI examine?
movement, sensation and reflex activity
50
what does the diagnosis of the neurological assessment describe?
level of vertebral fracture and extent of neurological deficit, to the last normal fxing segment of spinal cord
51
what does MMT detect?
changes in neurologic fx. gives info re: complete v. incomplete injury and level of injury
52
what do the sensory assessments detect?
changes in neurologic fx. | sensation organized in dermatomes that correspond with spinal nerves
53
what do the reflex assessments detect?
differentiation of upper motor neuron lesion and lower motor neuron lesion
54
what does the radiographic assessment document?
level of injury
55
what does the radiographic assessment provide info for?
info for level of stability of injury
56
what info does radiographic assessment not provide?
may not capture extent of bony displacement at moment of injury if the vertebrae has returned to normal alignment
57
what does the radiographic assessment demonstrate?
bone and soft tissue injury | alignment
58
what does CAT scan do?
outlines spine and perispinal structures clearly
59
what does MRI do>?
direct imaging of soft tissues, ie the cord, ligaments and intervertebral discs
60
what is emergency care of SCI?
stabilization for transport | breathing- ventilator support may be needed
61
what is post emergency care of SCI?
primary goal following ABC’s: decompress the spinal cord by realignment of the spinal canal closed reduction through skeletal traction surgical reduction with internal skeletal stability
62
what is spinal shock?
interruption of sympathetic nervous system
63
what is neurogenic shock?
body’s reaction to sudden interruption of central nervous system control
64
what are symptoms of spinal shock?
hypotension bradycardia hypothermia
65
what is hypotension?
low blood pressure, caused by passive vasodilation of the systemic vascular network below level of injury, decreased circulating blood volume and decreased cardiac output
66
what is bradycardia?
slow pulse
67
what is hypothermia?
body’s instability secondary to lack of vasomotor control hampers body’s ability to conserve body heat
68
why does spinal shock occur?
Body’s effort to stay alive after injury
69
what is cervical surgery?
internal surgery decompress spinal canal by removing all bony and soft tissue elements pressing against spinal cord obtain immediate stability for patient movement- via posterior approach using wires and bone grafts
70
how are wires and bone grafts used?
wiring of spinous processes graft using bone from iliac crest, fibula or tibia plates and screws
71
what is Thoracolumbar surgery?
internal stabilization technique using rods and/or fusion; sometimes screws and plates
72
when is a harrington rod used/
when stability needed after spinal cord injury after fall or trauma
73
when are bigger rods used?
scoliosis
74
when is fusion surgery used?
for stability
75
what are methods of external stabilization?
immobilization bed | Cervical Traction/Support
76
what are the tools used in cervical traction?
Tongs (attached to skull used to figure out what to do) or calipers Halo- rigid brace used later, after cervical traction with tongs
77
what kind of maintenance is needed for cervical traction?
maintenance of pin sites, traction
78
what are contraindications of a halo?
severe respiratory problems, chest injuries and burns on trunk or abdomen
79
what are examples of external cervical supports?
Semi-rigid cervical orthosis | Cervical collar: more rigid
80
what are examples of Thoracic and Lumbar Traction/Support?
Traction | Thorocolumbar orthosis
81
what is autonomic dysreflexia?
sudden severe headache secondary to an uncontrolled elevation in BP
82
what is autonomic dysreflexia caused by?
stimuli creating exaggerated response of the sympathetic nervous system i.e. Over-distended bladder, bowel impaction, urinary infection
83
when does autonomic dyreflexia occur?
mainly when T 4-6 or higher injury
84
how do you tx autonomic dysreflexia?
remove the aversive stimuli
85
what is Orthostatic or postural Hypotension?
Dramatic fall in BP when upright posture is assumed due to Disturbed vasomotor control with decreased blood supply returning to heart
86
when does orthostatic hypotension occur?
injury T4-6 or higher, with increased incidence at higher levels.
87
what is Deep Vein Thrombosis?
Development of a blood clot in the venous structures that Can lodge in heart, lungs, brain causing death
88
how do you tx deep vein thrombosis?
Clot meds, surgery
89
how do you prevent another deep vein thrombosis?
compression garments
90
What is heterotropic ossification?
bone grows where it shouldnt causing signs of localized inflammation or pain, elevated skin temp, etc.
91
where does heterotropic ossification usually occur?
major joint i.e. hip, knees, shoulders, elbows
92
where does heterotropic ossification occur in spinal cord?
below level of injury
93
how do you tx heterotropic ossification?
meds, radiation, operative resection (still risk recurrence), needs to run its course or surgery

Medpsych: Test 4 (8 decks)

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