Spinal Cord Injury

Question 1

What is tetraplegia (also known as quadriplegia)?

Answer 1

partial or complete loss of use of all four limbs

Question 2

What is paraplegia?

Answer 2

partial or complete loss of use of the lower extremities

Question 3

What is pentaplegia?

Answer 3

also called respiratory quadriplegia (quadriplegia plus impairment or loss of respiratory muscles)

Question 4

What are the two ways one can look at a level of vertebral injury? Explain the difference between the two.

Answer 4

SKELETAL:
vertebral level where vertebral bones and ligament dmg is most extensive

NEUROLOGICAL:
lowest segment of the spinal cord where bilateral sensory and motor function are normal

Question 5

What region of the spine can injury cause dmg to the phrenic nerve?

Answer 5

C3-C5

Question 6

What level can cause dmg to the nerves of the upper limbs?

Answer 6

C5-T1

Question 7

What region can affect the sympathetic nervous system?

Answer 7

T1-L4

Question 8

Above which level can tetraplegia occur?

Answer 8

C8

Question 9

Below which level does paraplegia usually occur?

Answer 9

T1

Question 10

What are the four mechanisms of SCI?

Answer 10

1) COMPRESSION; crush vertebrae and force fragments into spinal canal
2) ROTATION; tearing of ligaments that support the spine
3) HYPEREXTENSION; ruptures anterior ligaments
4) FLEXION; ruptures posterior ligaments

Question 11

What are the 5 types of spinal cord injuries?

Answer 11

1) Cord CONCUSSION
2) Cord CONTUSION
3) Cord COMPRESSION
4) LACERATION
5) TRANSECTION
6) HEMORRHAGE

Question 12

Describe a cord concussion

Answer 12

results in temporary disruption of cord mediated functions

short duration

Question 13

Describe a cord contusion

Answer 13

bruising of neural tissue causing swelling and temporary loss of cord mediated function

Question 14

Describe what a cord compression injury is.

Answer 14

it is pressure on the cord causing ISCHEMIA to the tissues.

Requires decompression to prevent permanent damage

Question 15

Describe what a transection spinal cord injury is.

Answer 15

It is severing of the spinal cord resulting in permanent loss of function

Question 16

Describe what a hemorrhage spinal cord injury is.

Answer 16

Bleeding into the neural tissue due to blood vessel damage.

Usually no major loss of function

Question 17

What ASIA grade is associated with a complete spinal injury?

Answer 17

Grade A

Question 18

What ASIA grades are associated with an incomplete spinal injury?

Answer 18

Grades B-D

Question 19

What is a complete spinal injury?

Answer 19

when you have COMPLETE loss of SENSORY and MOTOR function below level of injury

Question 20

What is an incomplete spinal injury?

Answer 20

MIXED loss of motor and sensory function

Question 21

What is the degree of loss dependent on in an incomplete spinal cord injury?

Answer 21

Level of injury and specific nerve tracts damaged

Question 22

What are the two levels of motor neuron injury one can have?

Answer 22

Upper and Lower injury

Question 23

How does upper motor neuron injury present?

Answer 23

As SPASTICITY as the reflex arc is untouched and complete its circuit

in this situation the motor neurons are unable to temper the responses and spasticity is seen (over control by reflexes with no regulation from upper)

Question 24

How does lower motor neuron injury present?

Answer 24

As FLACCIDITY as the reflex arc is broken before it contacts the spinal cord

Question 25

What are the two phases of spinal cord injury?

Answer 25

Primary phase Secondary phase

Question 26

Describe the primary phase of spinal cord injury.

Answer 26

Physical disruption of axons Maximal deficit is observed immediately Neurologic injury that occurs at the time of initial trauma or mechanical injury

Question 27

Describe the secondary phase of spinal cord injury

Answer 27

Ischemia, electrolyte imbalance (d/t things that alter cell membranes) and inflammatory responses begins immediately, may extend days Mechanical re-injury Release of endogenous substances at the injury site

Question 28

At what point is prognosis best determined at?

Answer 28

72 hrs post injury

Question 29

What are the two types of shock that can occur in SCI?

Answer 29

SPINAL shock NEUROGENIC shock

Question 30

What amount of people with SCI experience spinal shock?

Answer 30

50 percent

Question 31

Describe what SPINAL shock is

Answer 31

it occurs immediately after the injury it is complete, temporary loss of motor, sensory, reflex and autonomic function, and visceral sensation

Question 32

How long does SPINAL shock last?

Answer 32

about 48 hrs, but can last weeks as it resolves, person will regain some of the functions

Question 33

What is usually the cause of SPINAL shock?

Answer 33

disruption of communication of the spinal sympathetic nerves

Question 34

Describe what NEUROGENIC shock is

Answer 34

The temporary loss/disruption of autonomic function below level of injury Occurs soon after the injury Has a triad of symptoms

Question 35

What levels of injuries can NEUROGENIC shock occur with?

Answer 35

with cervical or upper thoracic injuries above T6

Question 36

How long does NEUROGENIC shock last?

Answer 36

about 3 days, but up to 3 weeks

Question 37

What are the triad symptoms associated with NEUROGENIC shock?

Answer 37

Bradycardia, hypotension, and inability to regulate temperature can have dilated peripheral vessels leading too decrease return and CO

Question 38

What are the characteristics of SPINAL shock below the level of injury?

Answer 38

decreased reflexes loss of sensation flaccid paralysis

Question 39

What is the priority of care in the prehospital phase?

Answer 39

Communication with EMS

Question 40

If the injury is above C4, what will the patient likely need?

Answer 40

mechanical ventilation

Question 41

What are the 5 phases of care for SCI?

Answer 41

1) prehospital resuscitation 2) ER resuscitation (primary survey/resuscitation, secondary survey) 3) Definitive/operative care 4) Critical care 5) Rehabilitation

Question 42

What are some priorities in the critical care phase?

Answer 42

Need to monitor breathing, effort, secretions, O2 May have vagal suppression which could cause cardiac arrest when moved inc r/o dvt (anticoag and SCD) dec venous return may need meds for bp monitor for bleeding be aware signs may be masked Monitor GI Fluid and electrolyte swallowing, tube feed may be necessary urinary retention overdistended bladders (can lead to renal failure, uti) careful repositioning (sensory dec) may need PPI to prevent ulcers

Question 43

What are the two types of Definitive care?

Answer 43

Surgical and Non surgical

Question 44

What are some common surgical interventions?

Answer 44

laminectomy with fusion Harrington rods spinal fusion

Question 45

What are some non surgical interventions in definitive care?

Answer 45

Cervical traction (ie halo) Immobilization of the neck in neutral position (ex halo vest) Brace tongs

Question 46

When can autonomic dysreflexia occur?

Answer 46

at any time after resolution of spinal shock

Question 47

What is autonomic dysreflexia?

Answer 47

an acute episode of exaggerated sympathetic response to a noxious stimuli (usually a distended bladder or constipation) below the level of injury

Question 48

Why does autonomic dysreflexia occur?

Answer 48

it is a result of a lack of control from the higher brain centers

Question 49

What level of injuries is autonomic dysreflexia associated with?

Answer 49

Associated with innuries t6 or higher lower ones usually have enough sympathetic outflow to control visceral reflexes

Question 50

What are the signs and symptoms of autonomic dysreflexia?

Answer 50

Severe hypertension, bradycardia, severe headache, nasal stuffiness, and flushing

Question 51

What should you do if autonomic dysreflexia is detected?

Answer 51

Have it treated immediately to prevent hypertensive stroke usually treated with rapid acting antihypertensives immediately

Question 52

What is the usual cause of neurogenic shock?

Answer 52

inability to control vascular smooth muscle