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MS3 Exam 2 > Spinal Cord Injury > Flashcards

Spinal Cord Injury Flashcards

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

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2
Q

The vertebrae

A

-when talking about SCI we identify the level of injury by the vertebraeCervical: C1-C7Thoracic: T1-T12Lumbar: L1-L5Sacrum: (S1-S5)–all 5 are fusedCoccyx: CO1-CO4–all 4 are fused

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3
Q

How many new incidents per year

A

12k

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4
Q

plurability are related to…

A

MVAs

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5
Q

Falls account for…

A

second highest incidence

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6
Q

Biggest at risk groups are…

A

men, young adults 16-30, Caucasians

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7
Q

Most SCIs occur at…

A

C1-5, T12, L1-3

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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

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9
Q

Etiology of SCIs

A

-excessive force to the spinal column in one of several ways

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10
Q

Hyperflexion

A

bend neck forwards

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11
Q

hyperextension

A

bend neck backwards

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12
Q

compression

A

landing on head or butt

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13
Q

rotational

A

bend neck to side or turn to side

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14
Q

transection

A

partial or complete severance

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15
Q

Grade A ASIA

A

-complete-no sensory or motor fx preserved in sacral segments S4-S5

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16
Q

Grade B ASIA

A

-incomplete-sensory but not motor fx preserved below the neurologic level and extending through sacral segments S4-S5

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17
Q

Grade C ASIA

A

-incomplete-motor fx preserved below the neurologic level-majority of key muscle have a grade less than 3

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18
Q

Grade D ASIA

A

-incomplete-motor fx preserved below the neurologic level-majority of key muscles have a grade greater than 3

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19
Q

Grade E

A

normal motor and sensory fx

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20
Q

Complete SCIs

A

-total loss of fx below level of injury

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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

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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

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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

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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
Q

Brown-Sequard Syndrome

A

-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
Q

Conus Medullaris Syndrome and Cauda Equina

A

-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 painbladder and bowel incontinence, constipation, etc-prognosis is poor for complete recovery, some possible

27
Q

saddle anesthesia

A

loss of feeling/sensation in areas you’d feel when sitting on a saddle

28
Q

Spinal shock

A

-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
Q

Spinal Shock Tx and Management

A

-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
Q

Primary or initial injury

A

-disrupts or severs nerve connections in one of the ways mentioned before

31
Q

secondary injury

A

-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
Q

scar tissue formation

A

cannot conduct nerve signals

33
Q

Effects of SCI

A

-generally speaking, all body systems and their fx will be inhibited in some form below the level of injury-paraplegia/tetraplegia

34
Q

Circulatory Characteristics to SCI

A

-injury higher than T5, inhibits SNS influence-prone to bradycardia-peripheral vasodilation…hypotension-autonomic dysreflexia

35
Q

Circulatory Care

A

-TED/SCD-anticoag therapy-cardiac monitoring-fluids-change position slowly for orthostatic hypotension

36
Q

Respiratory Care

A

-vent if needed-suction-pulse ox-blood gases-quad cough-pulmonary toilet

37
Q

quad cough

A

press abdomen inward during cough helps clear secretions

38
Q

pulmonary toilet

A

-bronchodilators-mucolytics-chest physiotherapy-breathing exercises-IS-all to clear secretions from airway

39
Q

Bowel/Bladder Characteristics

A

-incontinence-loss of urge-constipation-autonomic dysreflexia-urinary stasis–UTIs/kidney stones

40
Q

Reflexic

A

higher than T12-keeps reflex but spastic bladder-small uncontrolled voids

41
Q

Areflexic

A

lower than T12-flaccid bladder-no voluntary voiding-overflow incontinence

42
Q

Bowel/Bladder Care

A

-toilet frequently/bowel and bladder training-intermittent cath-foley/rectal tube-sx–cystostomy-anticholinergics–reduce contractions (Detrol)

43
Q

GI Characteristics

A

-decreased GI-monitor electrolytes if gastric suctioning present-pt may need swallow studies-high calorie, protein, and bulk diet

44
Q

Neurological

A

-neuro checks-poor thermoregulation-pain–psychotropic meds: Neurontin very common

45
Q

Neurontin

A

-anticonvulsant-txs nerve pain as well-monitor pts mood-motor coordination-eye movement*****!!!!!!

46
Q

Mobility

A

-paraplegia/quadriplegia/hemiplegia-proprioception-pain, touch, pressure, etc

47
Q

Mobility Care

A

-immobilization of neck-orthostatic hypotension-PT/Rehab/OT-toilet frequently-monitor for skin breakdown-ROM passive/active

48
Q

Psychosocial

A

-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
Q

Emergency Management

A

-maintain airway-prevent further injury-prevent spinal shock

50
Q

Initial Management

A

-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
Q

Care in Hospital

A

-MRI, CT, Xray-neuro checks-foley-methyprednisone-hazards of immobility

52
Q

hazards of immobility

A

-DVT management-pressure ulcers-continence/incontinence-atelectasis

53
Q

Traction

A

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
Q

Most common for cervical injuries

A

halos-external fixation

55
Q

Care of Ext Fixators

A

-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
Q

Medical Emergency care for SCIs

A

-maintain airway-prevent movement/immobilize site of injury-prevent shock

57
Q

Pharmacological Tx for SCIs

A

-generally symptom management with exception of methylprednisone

58
Q

Laminectomy

A

-removes lamina (back part of spinal vertebrae, to decompress spinal cord

59
Q

Vertebral fusion

A

joins vertebrae together

MS3 Exam 2 (6 decks)

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