Spinal Cord Injury Flashcards
(59 cards)
1
Q
Anatomy review
A
- spinal cord runs through the vertebral column with spinal cords extending out, into the body
- 31 pairs of spinal nerves
- 33 vertebrae in total
2
Q
The vertebrae
A
-when talking about SCI we identify the level of injury by the vertebrae
Cervical: C1-C7
Thoracic: T1-T12
Lumbar: L1-L5
Sacrum: (S1-S5)–all 5 are fused
Coccyx: CO1-CO4–all 4 are fused
3
Q
How many new incidents per year
A
12k
4
Q
plurability are related to…
A
MVAs
5
Q
Falls account for…
A
second highest incidence
6
Q
Biggest at risk groups are…
A
men, young adults 16-30, Caucasians
7
Q
Most SCIs occur at…
A
C1-5, T12, L1-3
8
Q
Patho of SCIs
A
- initial trauma which kills neuron, initiates inflammatory response
- reduced blood flow due to trauma, swelling, edema
- compression due to swelling from injury and inflammation
- WBCs bleeding into spinal cord causing more inflammation. Cytokine release may lead to scar tissue formation
- early intervention and tx can help limit degree of damage to spinal cord
9
Q
Etiology of SCIs
A
-excessive force to the spinal column in one of several ways
10
Q
Hyperflexion
A
bend neck forwards
11
Q
hyperextension
A
bend neck backwards
12
Q
compression
A
landing on head or butt
13
Q
rotational
A
bend neck to side or turn to side
14
Q
transection
A
partial or complete severance
15
Q
Grade A ASIA
A
- complete
- no sensory or motor fx preserved in sacral segments S4-S5
16
Q
Grade B ASIA
A
- incomplete
- sensory but not motor fx preserved below the neurologic level and extending through sacral segments S4-S5
17
Q
Grade C ASIA
A
- incomplete
- motor fx preserved below the neurologic level
- majority of key muscle have a grade less than 3
18
Q
Grade D ASIA
A
- incomplete
- motor fx preserved below the neurologic level
- majority of key muscles have a grade greater than 3
19
Q
Grade E
A
normal motor and sensory fx
20
Q
Complete SCIs
A
-total loss of fx below level of injury
21
Q
Incomplete SCIs
A
some feeling or movement remains
- central cord
- anterior cord
- posterior cord
- brown-sequard syndrome
- conus medullaris syndrome and cauda equina
22
Q
Central cord damage
A
- more severe motor loss in UE than LE
- bladder dysfunction, retention
- almost all will have some degree of recovery, usually starting in LE
23
Q
Anterior cord damage
A
- damage to anterior 2/3rds of cord
- loss of fx below level of injury
- loss of pain, temp sensations
- keep proprioception
- poor prognosis, some motor recovery may be possible
24
Q
Posterior cord damage
A
- very rare, damage to posterior portion of spinal cord
- most have good motor, pain, and temp control
- mainly loss of proprioception, light touch
25
Brown-Sequard Syndrome
- hemisection of spinal cord
- same side (ipsilateral) motor paralysis
- loss of proprioception below LOI
- opposite side (contralateral) loss of pain and temp sensation below LOI
- best prognosis, majority will be able to ambulate independently eventually with tx
26
Conus Medullaris Syndrome and Cauda Equina
- injury to tapered end of spinal cord (L1, rarely L2)
- not a true SCI, injury to spinal nerves branching from SC
- partial or complete loss of sensation below LOI, saddle anesthesia, low back pain
bladder and bowel incontinence, constipation, etc
-prognosis is poor for complete recovery, some possible
27
saddle anesthesia
loss of feeling/sensation in areas you'd feel when sitting on a saddle
28
Spinal shock
- not a true shock of the neurogenic, septic, etc
- occurs in about half of all SCI
- occurs immediately after SCI, within a few mins to hours
- even undamaged nerves lose fx for a bit
- loss of nervous system functioning due to decreases reflexes below level of injury, loss of sensation, flaccid paralysis below level of injury
29
Spinal Shock Tx and Management
- lasts between a week up to several months
- difficult to assess degree of permanent or chronic injury/loss of fx during this time
- want to avoid exacerbating injury
- immobilize spine and be careful moving
-steroids to reduce swelling
(typically methylprednisone titrated to pt weight)
30
Primary or initial injury
-disrupts or severs nerve connections in one of the ways mentioned before
31
secondary injury
- progressive damage which occurs after initial injury
| - swelling, edema, clotting, phagocytosis, etc. all may lead to impaired perfusion to nerve cells, loss of fx
32
scar tissue formation
cannot conduct nerve signals
33
Effects of SCI
- generally speaking, all body systems and their fx will be inhibited in some form below the level of injury
- paraplegia/tetraplegia
34
Circulatory Characteristics to SCI
- injury higher than T5, inhibits SNS influence
- prone to bradycardia
- peripheral vasodilation...hypotension
- autonomic dysreflexia
35
Circulatory Care
- TED/SCD
- anticoag therapy
- cardiac monitoring
- fluids
- change position slowly for orthostatic hypotension
36
Respiratory Care
- vent if needed
- suction
- pulse ox
- blood gases
- quad cough
- pulmonary toilet
37
quad cough
press abdomen inward during cough helps clear secretions
38
pulmonary toilet
- bronchodilators
- mucolytics
- chest physiotherapy
- breathing exercises
- IS
- all to clear secretions from airway
39
Bowel/Bladder Characteristics
- incontinence
- loss of urge
- constipation
- autonomic dysreflexia
- urinary stasis--UTIs/kidney stones
40
Reflexic
higher than T12
- keeps reflex but spastic bladder
- small uncontrolled voids
41
Areflexic
lower than T12
- flaccid bladder
- no voluntary voiding
- overflow incontinence
42
Bowel/Bladder Care
- toilet frequently/bowel and bladder training
- intermittent cath
- foley/rectal tube
- sx--cystostomy
- anticholinergics--reduce contractions (Detrol)
43
GI Characteristics
- decreased GI
- monitor electrolytes if gastric suctioning present
- pt may need swallow studies
- high calorie, protein, and bulk diet
44
Neurological
- neuro checks
- poor thermoregulation
- pain--psychotropic meds: Neurontin very common
45
Neurontin
- anticonvulsant
- txs nerve pain as well
- monitor pts mood
- motor coordination
- eye movement*****!!!!!!
46
Mobility
- paraplegia/quadriplegia/hemiplegia
- proprioception
- pain, touch, pressure, etc
47
Mobility Care
- immobilization of neck
- orthostatic hypotension
- PT/Rehab/OT
- toilet frequently
- monitor for skin breakdown
- ROM passive/active
48
Psychosocial
- high level cervical may impede ability to speak
- anxiety/depression related to prognosis/lifestyle changes
- disengagement from aspects of care they can manage or complete
49
Emergency Management
- maintain airway
- prevent further injury
- prevent spinal shock
50
Initial Management
-airway stays a priority
(O2 per NC, intubation)
- 1/3 will need intubation, especially high cervical injuries
- immobilize neck (rigid collar, spine board, log roll to turn, maintain neutral position, etc.)
51
Care in Hospital
- MRI, CT, Xray
- neuro checks
- foley
- methyprednisone
- hazards of immobility
52
hazards of immobility
- DVT management
- pressure ulcers
- continence/incontinence
- atelectasis
53
Traction
immobilization
- skeletal traction
- used to realign or reduce fracture
- must be maintained at all times
- do not change amount of weight
- weights must be free hanging
- if dislodged, stabilize and call for help
54
Most common for cervical injuries
halos
-external fixation
55
Care of Ext Fixators
- do not grab or lift by fixator
- clean pins around skin using saline + antibiotic cream
- keep wrench nearby, monitor pin placement
- if displaced, stabilize head of device with towels
56
Medical Emergency care for SCIs
- maintain airway
- prevent movement/immobilize site of injury
- prevent shock
57
Pharmacological Tx for SCIs
-generally symptom management with exception of methylprednisone
58
Laminectomy
-removes lamina (back part of spinal vertebrae, to decompress spinal cord
59
Vertebral fusion
joins vertebrae together
