What is tetraplegia (also known as quadriplegia)?
partial or complete loss of use of all four limbs
What is paraplegia?
partial or complete loss of use of the lower extremities
What is pentaplegia?
also called respiratory quadriplegia (quadriplegia plus impairment or loss of respiratory muscles)
What are the two ways one can look at a level of vertebral injury? Explain the difference between the two.
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
What region of the spine can injury cause dmg to the phrenic nerve?
C3-C5
What level can cause dmg to the nerves of the upper limbs?
C5-T1
What region can affect the sympathetic nervous system?
T1-L4
Above which level can tetraplegia occur?
C8
Below which level does paraplegia usually occur?
T1
What are the four mechanisms of SCI?
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
What are the 5 types of spinal cord injuries?
1) Cord CONCUSSION
2) Cord CONTUSION
3) Cord COMPRESSION
4) LACERATION
5) TRANSECTION
6) HEMORRHAGE
Describe a cord concussion
results in temporary disruption of cord mediated functions
short duration
Describe a cord contusion
bruising of neural tissue causing swelling and temporary loss of cord mediated function
Describe what a cord compression injury is.
it is pressure on the cord causing ISCHEMIA to the tissues.
Requires decompression to prevent permanent damage
Describe what a transection spinal cord injury is.
It is severing of the spinal cord resulting in permanent loss of function
Describe what a hemorrhage spinal cord injury is.
Bleeding into the neural tissue due to blood vessel damage.
Usually no major loss of function
What ASIA grade is associated with a complete spinal injury?
Grade A
What ASIA grades are associated with an incomplete spinal injury?
Grades B-D
What is a complete spinal injury?
when you have COMPLETE loss of SENSORY and MOTOR function below level of injury
What is an incomplete spinal injury?
MIXED loss of motor and sensory function
What is the degree of loss dependent on in an incomplete spinal cord injury?
Level of injury and specific nerve tracts damaged
What are the two levels of motor neuron injury one can have?
Upper and Lower injury
How does upper motor neuron injury present?
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)
How does lower motor neuron injury present?
As FLACCIDITY as the reflex arc is broken before it contacts the spinal cord
What are the two phases of spinal cord injury?
Primary phase
Secondary phase
Describe the primary phase of spinal cord injury.
Physical disruption of axons
Maximal deficit is observed immediately
Neurologic injury that occurs at the time of initial trauma or mechanical injury
Describe the secondary phase of spinal cord injury
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
At what point is prognosis best determined at?
72 hrs post injury
What are the two types of shock that can occur in SCI?
SPINAL shock
NEUROGENIC shock
What amount of people with SCI experience spinal shock?
50 percent
Describe what SPINAL shock is
it occurs immediately after the injury
it is complete, temporary loss of motor, sensory, reflex and autonomic function, and visceral sensation
How long does SPINAL shock last?
about 48 hrs, but can last weeks
as it resolves, person will regain some of the functions
What is usually the cause of SPINAL shock?
disruption of communication of the spinal sympathetic nerves
Describe what NEUROGENIC shock is
The temporary loss/disruption of autonomic function below level of injury
Occurs soon after the injury
Has a triad of symptoms
What levels of injuries can NEUROGENIC shock occur with?
with cervical or upper thoracic injuries
above T6
How long does NEUROGENIC shock last?
about 3 days, but up to 3 weeks
What are the triad symptoms associated with NEUROGENIC shock?
Bradycardia, hypotension, and inability to regulate temperature
can have dilated peripheral vessels leading too decrease return and CO
What are the characteristics of SPINAL shock below the level of injury?
decreased reflexes
loss of sensation
flaccid paralysis
What is the priority of care in the prehospital phase?
Communication with EMS
If the injury is above C4, what will the patient likely need?
mechanical ventilation
What are the 5 phases of care for SCI?
1) prehospital resuscitation
2) ER resuscitation (primary survey/resuscitation, secondary survey)
3) Definitive/operative care
4) Critical care
5) Rehabilitation
What are some priorities in the critical care phase?
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
What are the two types of Definitive care?
Surgical and Non surgical
What are some common surgical interventions?
laminectomy with fusion
Harrington rods
spinal fusion
What are some non surgical interventions in definitive care?
Cervical traction (ie halo)
Immobilization of the neck in neutral position (ex halo vest)
Brace tongs
When can autonomic dysreflexia occur?
at any time after resolution of spinal shock
What is autonomic dysreflexia?
an acute episode of exaggerated sympathetic response to a noxious stimuli (usually a distended bladder or constipation) below the level of injury
Why does autonomic dysreflexia occur?
it is a result of a lack of control from the higher brain centers
What level of injuries is autonomic dysreflexia associated with?
Associated with innuries t6 or higher
lower ones usually have enough sympathetic outflow to control visceral reflexes
What are the signs and symptoms of autonomic dysreflexia?
Severe hypertension, bradycardia, severe headache, nasal stuffiness, and flushing
What should you do if autonomic dysreflexia is detected?
Have it treated immediately to prevent hypertensive stroke
usually treated with rapid acting antihypertensives immediately
What is the usual cause of neurogenic shock?
inability to control vascular smooth muscle