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Spinal Cord Injury

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QuestionAnswer
What is the prevalence of spinal cord injury? 10-12,000/yearly
What is the major cause of death for spinal cord injury patients? Pneumonia/PE or Septicemia
Pathophys of SCI? Primary injury: initial mechanical insult usually irreversible. Secondary injury: usually triggered by spinal cord ischemia. Tissue injury response of Hypoxia, Edema and Ischemia.
Types of SCI? (Compression/Hyperflexion) COMPRESSION: FALLS FROM HEIGHTS, IE. CAUSES VERTICAL FORCE ALONG SC-> MAY CRUSH OR COMPRESS PIECES OF VERTABRAE OR BONEY PARTS INTO SC. TOP INJURY TO CERVICAL AREA HYPERFLEXION- HEAD ON COLLISION-> HEAD HYPERFLEXED FORWARD THEN SNAPPED BACKWARD
Types of SCI? (Hyperextension/Rotation) HYPEREXTENSION-> MVA’S-SC STRETCHES DISTORTED. BACKWARD-> DOWNWARD MOTION OF HEAD. THORACIC/LUMBAR AREAS MOSTLY AFFECTED. MAY HAVE NEURO DEFICITS DUE TO CONTUSIONS AND ISCHEMIA TO SC, NOT NECESSARILY BONEY ISSUES. ROTATION-> SEVERE ROTATION OF HEAD &/OR
SPINAL CORD VERTEBRAE CERVICAL SECTION 1-7 neck THORACIC SECTION 1-12 upper back LUMBER SECTION 1-5 lower back SACRAL SECTION 1-5 hip area COCCYGEAL 1-4 fused tailbone
Tx/mgmt of SCI ? Stabilization to prevent further injury Standard transport is C collar/backboard ABC’S Diagnostic testing: CT MRI X-RAY etc. Nonsurgical: HALO, ROTOREST Traction: Corsets Braces Shells Surgical: Laminectomy C1-C5 usually needs intubated Fluids-mai
TESTS X-RAY: R/O Fractures or dislocation of vertebrae and spinal processes. CT: anatomy of bone and assessing neurological symptoms & or pain. MRI: Visualization of cord and spinal cord and nerve roots Physical assessment Injury below t6 usually hemorrh
MEDICATION Methylprednisolone (Solu-medrol)-Controversial because of side effects Anticoagulants Vasopressors- for BP Blood products- due too internal injuries IV FLUID-keep bp stable
What is spinal shock? Temporary loss of SC function Non-Preventable T6 and above Neuronal injury 50% will get this, it’s temporary so need to wait to assess
What is neurogenic shock? Hemodynamic instability Triad:Hypotension,Bradycardia,Temperature instability (Poikilothermia) body assumes room temperature
Cardiac: arrythmias/bradycardia SCI Esp in cervical injuries: Injury or interruptions to the cardiac accelerator nerves can cause B/P instability, and arrhythmias. Tachycardia or bradycardia can occur. R/O hypovolemic shock ( heart rate would be tachy)
Cardiac :orthostatic hypotension SCI Low B/P may be caused by pooling of blood in small arteries away from the heart, due to loss if tone in blood vessels-> treated with IV fluids to increase blood volume
Cardiac: DVT/PE SCI Blood clots-> 3x’s the risk after 72 + hours post injury-> Consider anticoagulation therapy.
Cardiac :Altered thermoregulation SCU Sympathetic nervous system interruptions above T6-7 can cause a loss in autoregulatory control of B/P (get hypotensive can last for months) and temperature. The body is unable to sweat or shiver so can’t control it’s temperature. Peripheral dilation makes
GASTROINTESTINAL SCI Most develop ileus due to spinal shock NPO NG tube Ulcers Metabolic Stress Syndrome-may need high caloric supplements. When in rehab: calorie count
GU: Neurogenic Bowel Injury level above T12 (UMN) Reflex : Brain doesn’t get the message bowel is full. Sphincter muscle tight. Bowel empties by reflex(reflexic) Bowel program: Diet, Stool Softeners, Suppositories and or Digital Stimulation
GU- BOWEL Injury level below T12 (LMN) Flaccid Bowel: Doesn’t get message, reflex doesn’t work, sphincter (anal) muscles stay relaxed (areflexic). Bowel program: Suppositories, Digital stimulation or disempaction. Start every other day.
Bowel Teaching Try to train bowel. Do program same time each day. Sit if possible: gravity Commode: not bedpan IF side laying: Left side Long term: may lead to Colostomy
Neurogenic GU/Bladder UTI and renal dysfunction are long term causes of morbidity & mortality At time of injury most have foley placed SCI bladders: REFLEX or FLACCID Reflex (autonomic or spastic) above T12 Treatment: ICP, Indwelling or condom cath catherization every 4 ho
GU/BLADDER Flaccid bladder: T12 and below (non-reflex). Treatment ICP preferred. Dyssynergia: spincter muscle stays contracted when bladder contacts. Treatment: medications or surgery
AUTONOMIC HYPERREFLEXIA AUTONOMIC HYPERREFLEXIA The most common medical emergency can lead to stroke->death The most life threatening condition of SCI T6 and above.
Autonomic dysreflexia Occurs when a noxious stimuli triggers intact sensory nerves below the level of injury. Unique to SCI Precipitating factors: Bladder/Bowel distention. Pressure or irritation (esp: genitals) constricted clothing.
Autonomic dysreflexia -above and below injury Above level of injury: flushed skin, profuse perspiration Below level of injury: cool, pale skin, Goos
Created by: UARN85