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Spinal Cord Injury

QuestionAnswer
Spinal Shock Temporary loss of all spinal reflex activity BELOW level of injury. Flaccid paralysis, areflexia, loss of sensation. Lasts days to weeks.
Neurogenic Shock Hemodynamic instability from loss of sympathetic tone (T6 or above). Bradycardia, hypotension, hypothermia, warm/dry skin below injury.
Autonomic Dysreflexia (AD) Patho Massive, uncontrolled sympathetic reflex from noxious stimulus BELOW injury (T6 or above). Unopposed because signal can't ascend.
AD Common Triggers Bladder (distention, UTI, kinked catheter) #1. Bowel (constipation, impaction). Skin (pressure injury, tight clothes). Pain.
AD Immediate Nursing Action SIT PATIENT UP (High Fowler's) to drop BP via orthostasis. Then find and remove trigger (check bladder first!).
Complete vs Incomplete SCI Syndromes Complete: No motor/sensory below. Incomplete: Brown-Sequard, Central Cord, Anterior Cord syndromes with varying deficits.
Brown-Sequard Syndrome Hemi-section of cord. Ipsilateral motor loss and proprioception loss below injury. Contralateral pain & temp loss 1-2 levels down.
Central Cord Syndrome From hyperextension in elderly. Motor/sensory loss greater in arms than legs. "Burning hands" sensation. Good recovery prognosis.
Anterior Cord Syndrome From flexion injury. Motor paralysis and pain/temp loss below injury. Proprioception/vibration sense preserved (posterior columns intact).
Respiratory C1-C3: Ventilator dependent. C3-C5: Diaphragm impairment (phrenic nerve). T1-T12: Intercostal impairment (cough weak).
Paralytic Ileus Common in acute phase. NGT to low suction. Monitor bowel sounds, abdominal distension. Advance diet slowly.
Neurogenic Bladder Spastic/Reflexic (UMN lesion) or Flaccid/Non-reflexic (LMN lesion). Requires intermittent catheterization or indwelling cath.
Prevent Ortho Hypo Use abdominal binder, TED hose, tilt table, gradual position changes. Meds: Midodrine, fludrocortisone.
Created by: Wasurenboh
 

 



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