Edema
always happen with SCI...and causes a decrease in fxn
Where is the worst part of the spinal cord to have edema and why?
cervical
C1 and C2 fractures with edema can cause death.
In the area of C3-C5 the edema can cause phrenic nerve dysfunction and respiratory paralysis
Diaphragm is inervated by ....
C4
When assessing a patient with a suspected SCI always assess this first....
breathing patterns
If a person has a C4 or above SCI what will I notice?
shallow, guppy breathing...respiratory arrest is coming
For a person with a SCI, first 2 interventions
ABC-intubation
C spine collar...no twisting or moving of the head and neck
How can you quickly tell if a patient has an injury at C5 or above?
Tell they to take a deep breath....if the can, then the injury is lower than C5
What SCI is the most life threatening
cervical
Spinal precautions
no flexion/rotation of the patients head
cervical collar
backboard
sandbags
log roll
What will help me to predict the level of independence my patient will be above to have when they recover?
knowing their level of injury
What is given to SCI patients within 3 hours of their injury and for the next 48 hours
high dose IV methylprednisolone
minimizes swelling and preserves function
Acute treatment for SCI
methylprednisolone
IV fluids
DVT prophylaxis
NG tube for nutrition
Temp control
Position change for stress ulcers
Bowel and bladder training
When does neurogenic shock occur? Describe it....
3 days to 3 weeks after the injury
it is loss of vasomotor tone and impairment of autonomic function....seen a lot with cervical injuries
Why do people with cervical injuries get neurogenic shock?
cuz it can disrupt the sympathetic nervous system pathway, leading to a loss of sympathetic control....parasympathetic is in control
What happens when the parasympathetic nervous system takes over....
vasodilation of vascular beds causing hypotension
vagus nerve stimulated by parasympathetic causing bradycardia
loss of ability to sweat below the level of injury...no connectiong btwn hypothalamus and symp. nervous system
If a persons BP and HR are dropping from neurogenic shock what do I give?
Dopamine and/or Atropine
What's spinal shock and how long does it last?
loss of spinal reflexes and the resulting flaccid paralysis below the level of injury
lasts weeks to months
What occurs with spinal shock?
complete loss of motor, sensory, reflex and autonomic function below the level of injury
Describe what the person will present like who is experiencing spinal shock
flaccid, total paralysis of all skeletal muscles below the level of the injury
loss of spinal reflexes below the level of injury
loss of pain, proprioception and sensations to touch, temp, pressure, below the level of injury
*unstable lower BP
*loss of ability to perspire below the level of the injury
*bowel and bladder dysfunction
*priapism-erect penis cant return to flaccid
When a person is experiencing bowel and bladder dysfunction with spinal shock...what kind and how is it treated?
atonic bladder....they have not reflex to void
have to do bladder training.....NO foleys cuz of risk for infection
Describe recovery from spinal shock
once resolved, remaining deficits are permanent
lasts 1-6 weeks
it's a gradual process in which the spinal neurons slowly regain their excitiability
amount and type of recovery depends on degree of injury
Medical management of a person with a SCI
#1 ABC
#2 Cervical spine stabilization...possible surgery too
Methylprednisolone IV Bolus
Motor and sensory exam
X rays, CT, MRI
Laminectomy
removal of the lamina of the vertebral ring to allow decompression or removal of bony fragments from the spinal canal
Spinal fusion
surgically fusing 2-6 vertebral segments together to provide stability...done with plugs or bone chips taken from the iliac crest
Rodding
stabilization and realignment of larger segments of the spinal column
*most common with thoracic injuries
Halo traction
done pre surgery, or if a person doesn't require surgery ....usually thoracic injury
8-12 weeks, can walk around....watch for skin irritation
Foremost cause of early death after acute SCI
pulmonary issues.....
atelectasis
pneumonia
pulmonary emboli
6 common complications post SCI
pulmonary issues
orthostatic hypotension
GI Bleed due to stress ulcers
paralytic ileus
atonic bladder
skin integrity issues
When does autonomic dysreflexia occur? Why does it happen?
6 weeks after injury
any injury that is T6 or above is at risk....
due to interruption in the feedback loop of the autonomic nervous system. Any irritation below the level of the injury stimulates and exaggerated, unopposed autonomic response
What will a person present like if they are having autonomic dysreflexia?
Sudden severe headache
nasal congestion
facial flushing
elevated BP
Bradycardia
Interventions for a person experiencing autonomic dysreflexia
Sit them up immediately...decreases BP
Investigate the cause
Treat cause
Give sublingual Niphedipine and monitor BP....or Apresoline IV
#1 Cause of autonomic dysreflexia
#1 bladder issues....so try to stimulate urination, may need to straight cath them
or check for obstruction
Atropine to relieve bladder tetany
3 causes of autonomic dysreflexia
bladder issues/obstructions
bowel blockages...fecal impaction
skin issues
How can skin issues cause autonomic dysreflexia?
clothes are too tight
look for irritations like pimples, boils, pressure sores, in grown toenails
Medications to treat autonomic dysreflexia
Nifedipine sublingual
Apresoline IV
Hyperstat