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| What is the prevalence of spinal cord injury? | 10-12,000/yearly
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| What is the major cause of death for spinal cord injury patients? | Pneumonia/PE or Septicemia
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| 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.
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| 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
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| 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
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| 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
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| 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
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| 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
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| MEDICATION | Methylprednisolone (Solu-medrol)-Controversial because of side effects
Anticoagulants
Vasopressors- for BP
Blood products- due too internal injuries
IV FLUID-keep bp stable
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| 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
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| What is neurogenic shock? | Hemodynamic instability
Triad:Hypotension,Bradycardia,Temperature instability (Poikilothermia) body assumes room temperature
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| 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)
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| 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
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| Cardiac: DVT/PE SCI | Blood clots-> 3x’s the risk after 72 + hours post injury-> Consider anticoagulation therapy.
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| 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
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| 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
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| 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
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| 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.
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| 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
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| 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
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| GU/BLADDER | Flaccid bladder: T12 and below (non-reflex).
Treatment ICP preferred.
Dyssynergia: spincter muscle stays contracted when bladder contacts.
Treatment: medications or surgery
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| AUTONOMIC HYPERREFLEXIA | AUTONOMIC HYPERREFLEXIA
The most common medical emergency can lead to stroke->death
The most life threatening condition of SCI T6 and above.
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| 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.
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| Autonomic dysreflexia -above and below injury | Above level of injury: flushed skin, profuse perspiration
Below level of injury: cool, pale skin, Goos
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