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Patho 3 (Path 312) > Spinal Cord Injury (Mod 1) > Flashcards

Spinal Cord Injury (Mod 1) Flashcards

1
Q

Where do we typically see respiratory issues in relation to spinal cord injuries?

A

T6 and above = ability to cough and inhale are impeded (diaphragm and such are deeply affected)

  • C345 keep the diaphragm alive.
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2
Q

How many spinal nerves are there?

A

31 nerve pairs; one on each side of vertebral column

  • Mix of motor, sensory, and autonomic function
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3
Q

What are the affected systems by autonomic dysfunction from spinal nerve injury

A
  1. High lesions (above T6) result in reduction of sympathetic nervous system activity and vagus nerve stimulation
  2. Cardiac - Hypertension, arrythmias and brady most common (pacemaker)
  3. Respiratory - Bronchial reactivity (atrovent, ventolin)
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4
Q

What is motor and sensory functions influenced by?
- don’t worry about as much.

A

Local site of injury and level of recovery

  • monitored by Asia scale throughout recovery
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5
Q

What is traumatic spinal injury?

A

Impact to the spine that fractures, dislocated, or compresses 1 or more of the vertebrae

  • most common, spectrum
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6
Q

What is non traumatic spinal injury?

A

May be caused by inflammation, cancer, infection, disc degeneration

  • If patients are palliative, are they treating it, important to understand individual care plan
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7
Q

What are the 3 different categories of spinal injury?

A
  1. High C Spine (C1-C2)
  2. Mid-Low C spine (C3-C8)
  3. T spine Injury
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8
Q

What are the implications of a High C spine injury

A

High C spine injury pts would be vent dependant for the rest of their life

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9
Q

Mid low c spine injury complications?

A

May need cough assist and volume recruitment with their lives

  • includes assisted night ventilation
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10
Q

T spine injury implications?

A
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11
Q

Be aware of and look at slide 9; but it won’t be tested specifically.

  • good idea to look at though
  • add to slides and just look at it
A
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12
Q

Incomplete or complete spinal injury?

A
  1. Incomplete = preservation of sensory of motor function below level of injury
  2. Complete = Absence of sensory and motor function below level of injury
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13
Q

What are 4 types of Vertebral Fractures?

  • SLide 11 - Describe later in separate cards
A
  1. Compression
  2. Burst
  3. Flexion/Distraction
  4. Dislocated
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14
Q

Signs and Symptoms of a Spinal Injury

A
  • Suspected mechanism of injury (fall, trauma)
  • Pain/Pressure in neck or back
  • Weakness or paralysis (can be immediate or take time as swelling occurs)
  • Numbness, tingling, loss of sensation
  • Loss of bladder/bowel control
  • Respiratory Failure (abdominal paradox if diaphragm impaired)
  • Hypotension, Bradycardia
  • Loss of bulbocavernous reflex (Indicative of Spinal Shock)
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15
Q

Review slide 13 later

A
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16
Q

When does Neurogenic shock occur when a spinal injury occurs?

A

SCI above T6

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17
Q

What are the implications of Neurogenic shock that results from spinal cord injuries?

A

Loss of sympathetic tone and vasodilation

  • Hypotension, bradycardia, bronchoreactivity
  • Lost of ability to sweat below level of injury
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18
Q

What are treatment options for neurogenic shock that results from spinal injury?

A

Supportive until injury is diagnosed and treated

  • Fluid and inotropes to maintain MAP
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19
Q

What are weaning considerations for a Pt that suffers a spinal injury?

A

Dependant on recovery, level, and severity of injury

  • VC > 15 ml/kg for extubation
  • Weaning is often slow and cautious in these situations
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20
Q

What are decannulation considerations for a pt with a tracheostomy that suffers a spinal injury?

A
  1. Swallowing
  2. Effectiveness of cough
  3. Tracheal Stent
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21
Q

What complications are associated with allowing a cuff leak for pts that are permently ventilated?

A

Loss in delivered volumes

  • Speech therapy
  • Communication
  • Infection risk
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22
Q

Initial respiratory management for spinal injuries?

A
  1. Mechanical ventialtion
  2. Tracheostomy
  3. Non invasive ventilation
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23
Q

When would non invasive ventilation be considered for spinal injuries

A

For low c spine injuries with higher lung volumes (long term options)

  • Pts may suffer from OSA
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24
Q

What does of Maintenance of Lung Volumes involve for patients with chronic injury during the acute phase?

A

Reducing VC by 20-60% depending on level of injury/progress

  • Lung volumes are variable over recovery
  • Vital capacity monitoring (SVC)
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25
What does of Maintenance of Lung Volumes involve for patients with chronic injury?
Interventions often done in conjunction w/physical therapy and assisting cough. - **Intermittent manual breathing** - Breath stacking (MLVRM = one way valve bagger) - MIE - Glossopharyngeal breathing - Abdominal Binding - Like the acute phase; we still want to reduce VC
26
What secondary layer of therapy can breath stacking with a MLVRM provide?
Secretion clearance (cough assist) - may require pt education w/fam later down the line
27
What are the risks of MLVRM (breath stacking) and how do you mitigate the risk?
Risk of pneumothorax because of the one way valve - mitigate risk by corredinatin with the pt - Ensure that cuff is down if one is present (can be done up but risk is high)
28
Should the cuff be inflated or deflated for a MIE?
Inflated?
29
What is MIE?
30
How is the ability to produce a Cough affected by spinal injury (generally)?
Ability to produce effective cough is decreased due to loss of innervation to abdominal and inner intercostal muscles - other muscles could be recruited to compensate depending on the level of injury - Both a large insp and exp effort are needed for an effective cough
31
How is effective cough assessed?
Peak Cough Flow - Normal > 360-400 L/Min
32
What is normal Peak Cough Flow
Normal > 360-400 L/Min
33
What could affect with Peak cough flow results?
Tracheostomy tube
34
What could help produce a large insp and exp effort for a effective cough
1. Pt compliance 2. MIE 3. MLVRM and Abdominal/manually assisted cough
35
What are the risks of a ineffective cough or poor bronchopulmonary hygiene?
Pneumonia - Ineffective cough, poor lung volumes, poor swallow, and need for trach put SCI pts at increased risk - **Increased risk of resp failure due to pneumonia when VC < 200ml** - Quick action on therapy would antibiotics and humidity.(make it a slide on its own)
36
Add slides 19-21 forward
37
Anatomy of the spine columns (segments) - i.e cevical?
- Cervical (7) - Thoracic (12) - Lumbar (5) - Sacral (5 + fused) - Coccygeal (4 + fused)
38
Acute Spinal cord injury managment?
Usually involves stabilization, confirmation of injury, and neuroprotection which involves: - C spine collars/braces - CT/MRI - Shock management - Surgical stabilization/removal of foreign objects. - Neuroprotection (Hypothermia via prednisone)
39
What kind of shock is usually associated with SCI?
Neurogenic/distributive shock
40
What complications are associated with spinal shock (neurogenic)?
Loss of sympathetic tone and vasodilation - loss of ability to sweat below level of injury - Hypotension, bradycardia, bronchoreactivity
41
Treatments for spinal shock (neurogenic)?
Supportive until injury is diagnosed and treated by: - Fluids and inotropes to maintain MAP
42
Weaning management plan for SCI?
The usual, but VC needs to be > 15 for extubation - some cases need permeant trachs -NIV is a long term option post extubation for low C spine injuries with higher lung volumes
43
Quick action plan for pneumonia for SCI patients?
Antibiotics and humidity. - patients can't clear secretions and at higher risk of resp failure due to pneumonia when VC < 200ml
44
How is VC affected by SCI?
Reduction of VC by 20-60% depending on level of injury/progress during recovery.
45
Why are interventions such as MIE, breath stacking, or physio important to managing SCI patients?
SCI patients can't maintain lung volumes due to diaphragm weakness...or cough - untreated issues could lead to derecruitment of lung volumes or atelectasis (chest wall rigidity)
46
When is pulmonary embolism at the highest risk of developing?
3 months after injury, but increased risk remains after 3 months (poorly documented)
47
Treatment options for pulmonary embolism associated with SCI?
A bunch of just in case therapies aka prophylactics - Prophylactic anticoagulant therapy - Prophylactic IVC filter
48
Why is Abdominal Cough Assist contraindicated for SCI with pulmonary **embolism**
Increase in intrathoracic pressure can potentially dislodge or worsen a pulmonary embolism by **forcing the embolus further into the pulmonary circulation**, leading to more severe obstruction of blood flow in the lungs.
49
Hemodynamic risks associated with pulmonary embolism?
pulmonary embolism are at risk of hemodynamic instability due to compromised blood flow to the lungs; could affect systemic blood pressure and cardiac function
50
Why is pulmonary edema at risk of developing for acute SCI patients?
Excessive fluid admin to treat hypotension due to neurogenic shock
51
Therapies to prevent atelectasis if SCI causes reduced lung volumes?
Lung volume maintaince therapy: MLVRM, IPPB, MIE
52
C1-C2 injury Impact on breathing
Severe requiring mechanical ventilation - Diaphragm is completely paralyzed (Phrenic nerve C345) - Loss of all resp muscle function
53
C3-C5 injury impact on breathing
Severely weakens or ceases diaphragm function - may require ventilatory support - night time support - Risk of resp infections due to inability to clear secretions effectively
54
C6-C8 injury impact on breathing
Don't typically affect the diaphragm, breathing is not significantly impaired. - Diaphragm is still fully functional - Accessory resp muscles may be weakened = weak cough and/or weak deep breathing
55
Ventilator dependent C Spine injury?
C1-C3
56
Possible ventilation or NIV dependent C spine injury?
C3-C4
57
C spine injury independent respirations
Possible paralysis of abdomen and impaired coughing but generally: - C5 - C6-8
58
Full normal respiratory spinal cord injury location?
T12 and lower - Injuries in the T1-T11 region may weaken the diagram or accessory respiratory muscles at varying degrees but still be able to retain breathing
59
Sign and symptoms of spinal cord injury (SCI)
Suspected mechanisms pain pressure in back - weakness or paralysis - numbness loss of sensation loss of bowel control - respiratory failure - Hypotension, bradycardia
60
What is spinal shock
Flaccidity of muscles and loss of reflexes (hyporeflexia) - may have altered body temp, skin color changes, no sweating, hypotension
61
What is a Compression injury?
Vertebral body compressed anteriorly result of fall or osteoarthritis
62
Whats a Burst Injury
vertebrae crushed by extreme forces. Body fragments can cause additional injury such as in a Car accident
63
Whats a Flexion/Distraction
Injury involves posterior and middle spinal columns - Severe whiplash
64
Whats a dislocated injury?
Any type of injury with a moved vertebrae - very unstable - may cause cord injury or severing.
65

Patho 3 (Path 312) (10 decks)

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