Spinal Cord & Peripheral Nerve Problems

Question 1

Mechanism of injury

Answer 1

Flexion injury: most common
-hit steering wheel

Hyperextension:
Hit chin

Compression:
Fall, diving

Question 2

Primary vs secondary injury

Answer 2

Primary: initial injury
-Cord compression
-Cord ischemia
-Penetrating trauma

Secondary injury: happens after injury
-edema and ischemia

Question 3

Patho

Answer 3

Injury= edema, ischemia, vasoconstriction

Limited space, edema

Increases ischemia

Extent of injury usually after 72 hours

Question 4

Patho
RBC and plts

Answer 4

Release:
-norepi
-serotonin
-dopamine

Lead to:
Vasoconstriction

Question 5

Patho
Breakdown of RBCs

Answer 5

Increased free radical formation
Then
Tissue hypoxia

Question 6

Patho
Neutrophils

Answer 6

Vasospasm/edema
Then
Decreased spinal cord blood

Question 7

Complete vs incomplete

Answer 7

Complete:
Total loss of sensory and motor below injury

Incomplete:
Mixed loss of voluntary motor and sensory, some intact

Question 8

Injury
C4
C6

Answer 8

C4:
Tetraplegia
Results in complete paralysis below the neck

C6:
Partial paralysis of hands and arms
And lower body

Question 9

Injury
T6
L1

Answer 9

T6:
Paraplegia
Paralysis below the chest

L1:
Paraplegia
Paralysis below the waist

Question 10

Complication
Spinal shock

Answer 10

Immediate response to injury
Usually c-spine injury

Complete loss of reflex activity below injury
Flaccid paralysis
Loss of sensation
No thermoregulation

Question 11

Complication
Neurogenic shock

Answer 11

Usually c-spine injury

-Loss of vasomotor tone
-Decreased SNS leads to vasodilation (cant compensate w/ -tachycardia, only shock that does this)
-HOTN
-Brady cardiac
(Support BP/HR)

Question 12

Diagnostic test

Answer 12

CT: gold standard (locate injury)

MRI

Xray: harder to see amount of damage

Question 13

Emergency management
Prehospital

Answer 13

A,B,C,D
Patent airway
O2 sat >90%
SBP >90: may need IV fluids, vasoactive meds
IV 2 large bore IV or IO

Question 14

Emergency management
Acute care

Conyinue what
D
Stabilize spine how

Answer 14

Continue prehospital support ABC

D=disability, assess neuro
-motor assessment
-sensation
-rectal tone

Stabilize spine:
-logroll
-c-collar

Question 15

Stabilization

Answer 15

Traction
Pin care
If traction becomes displaced: Notify Provider

Decompression sx
Spinal fusion: pos op may need to wear brace/c-collar

Stable injury: no sx needed but may need Halo or Brace

Question 16

Management
Respiratory
C1-3
C4
C5
Interventions

Answer 16

C1-3: apnea, inability to cough (req vent)

C4: poor cough, diaphragmatic breathing, hypoventilation (check CO2)

C5: decreased resp reserve

Interventions:
Chest PT
Suction
O2

*C5 keep the diaphragm alive

Question 17

Management
Cardiac

Answer 17

Early problems: shock
-HOTN: vasoactive meds & IVF(1st then meds)
-bradycardia: meds/pacemaker

orthostatic HOTN (d/t decreased SNS)
S/s: lightheaded, dizzy, dec LOC
Tx: abdominal binder, compression stocking (help venous return)
Meds: fludrocortison (inflammation)
DVT prevention

Question 18

Management
GI

Answer 18

Nutrition: high calorie, protein, fluids and fiber
Constipation risk (fiber)
Neurogenic bowel (cant go)

Bowel training daily at regular time:
-stool softener, laxatives, digital stimulation
-30-60min after meal
-up in chair if possible

Question 19

Management
GU

Answer 19

Neurogenic bladder
No sensation of bladder fullness

Tx:
Self cath 4-6 times/day
Teach aseptic technique
Teach s/s of UTI

Question 20

Autonomic hyperreflexia or dysreflexia
What is it
Where injured
What happens below injury
S/s

Answer 20

It is: the Return of reflexes after shock
Injury above T6
Bowel/bladder distension, pain

Vasoconstriction below injury:
>20 risk in BP but can go to 300

S/s
HA, flushing, diaphoresis, bradycardia, nasal stuffiness, seizures

Question 21

Autonomic hyperreflexia or dysreflexia tx

Answer 21

Pt education when to call for assistace

-Meds to lower BP
-Elevate HOB 45 degrees
-Loosen clothing
-Bladder scan then straight cath
-Digital rectal stimulation

After it subsides: monitor for 3-4 hours
Always check BP when pt with tetraplegia reports HA

Question 22

Autonomic hyperreflexia or dysreflexia management
Temp
Skin
Stress ulcers

Answer 22

Temp:
Decreased ability to sweat or shiver
No excessive covers
Careful heat loss during bath

Skin: same as always

Stress ulcrs: PPI H2

Question 23

Autonomic hyperreflexia or dysreflexia management
Pain:
Nocireceptive pain
Neuropathic pain
Reflexes return

Answer 23

Nociceptive pain:
Dull, tender, cramping
Thorax, abdominal, pelvis
Assess bowel and bladder

Neruopathic pain:
Tingling, burning shooting, electric pain
Tx: Gabapentin (neurontin)

Reflexes return:
Penile erection
Spasms
Tx: Baclofen

Question 24

Autonomic hyperreflexia or dysreflexia management
Male sexuality
Female

Answer 24

Male:
Reflex erections: uncontrolled, cant maintain
ED meds: penile pump external or implanted prosthesis
Fertility but sperm quality is low

Female:
Remains fertile
Cant feel uterine contractions (scary for pregnancy)

Question 25

Bells palsy What is it What nerve is effected Long it last

Answer 25

Acute peripheral facial paresis Inflammation facial nerve CN VII Weeks to months Unknown cause

Question 26

Bells palsy CM

Answer 26

Unilateral facial weakness Numbness: face, tongue, and ear Tinnitus HA Hearing deficit Decreased muscle tone: -face droop, flattened nasal labial fold, unable to smile/frown, difficulty chewing Inability to close eye: risk for corneal abrasions

Question 27

Bells palsy Diagnostic test Tx

Answer 27

R/o stroke: H&P, CT Tx: Moist heat, gentle massage Corticosteroids: done before paralysis Antivirals: for infection Chew on unaffected side Articifial tears, tap eyes shut at night

Question 28

Guillain-Barre syndrome Kind of issue Damage to what Often preceeded by what Patho

Answer 28

Autoimmune Damages peripheral nervous system (polyneuropathy) Often preceded by GI or URI, vacinnation or sx, and Zika virus Pathogens: damage to myelin, edema and inflam. of nerves

Question 29

Guillain-barre syndrome Diagnostic test

Answer 29

H&P EMG: measure muscle weakness from polyneuropathy Nerve conduction studies: slow

Question 30

Guillain-barre syndrome CM Begins with Maximum deficit when What is involved and some s/s of it Risk for what

Answer 30

Begins w/: weakness/abnormal sensation in arms & legs It declines distal to proximal Return function proximal to distal Maximum deficit by 2-4 weeks Sympathetic and parasynmpathetic NS involved= Orthostatic HOTN, cardiac dysrhythmias, bowel & bladder dysfunction Risk for respiratory muscle paralysis

Question 31

Guillian-barre syndrome management

Answer 31

Hospitalized to monitor Mechanical ventilation possible Slowed bowels: paralytic illeus IV ig immunoglobulin therapy (helps w/ antibodies) Plasmapheresis(exchanging plasma) helps with/ antibodies Recovery is slow