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Edema
always happen with SCI...and causes a decrease in fxn
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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
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Diaphragm is inervated by ....
C4
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When assessing a patient with a suspected SCI always assess this first....
breathing patterns
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If a person has a C4 or above SCI what will I notice?
shallow, guppy breathing...respiratory arrest is coming
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For a person with a SCI, first 2 interventions
ABC-intubation
C spine collar...no twisting or moving of the head and neck
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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
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What SCI is the most life threatening
cervical
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Spinal precautions
- no flexion/rotation of the patients head
- cervical collar
- backboard
- sandbags
- log roll
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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
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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
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Acute treatment for SCI
- methylprednisolone
- IV fluids
- DVT prophylaxis
- NG tube for nutrition
- Temp control
- Position change for stress ulcers
- Bowel and bladder training
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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
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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
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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
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If a persons BP and HR are dropping from neurogenic shock what do I give?
Dopamine and/or Atropine
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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
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What occurs with spinal shock?
complete loss of motor, sensory, reflex and autonomic function below the level of injury
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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
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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
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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
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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
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Laminectomy
removal of the lamina of the vertebral ring to allow decompression or removal of bony fragments from the spinal canal
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Spinal fusion
surgically fusing 2-6 vertebral segments together to provide stability...done with plugs or bone chips taken from the iliac crest
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Rodding
stabilization and realignment of larger segments of the spinal column
*most common with thoracic injuries
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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
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Foremost cause of early death after acute SCI
- pulmonary issues.....
- atelectasis
- pneumonia
- pulmonary emboli
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6 common complications post SCI
- pulmonary issues
- orthostatic hypotension
- GI Bleed due to stress ulcers
- paralytic ileus
- atonic bladder
- skin integrity issues
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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
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What will a person present like if they are having autonomic dysreflexia?
- Sudden severe headache
- nasal congestion
- facial flushing
- elevated BP
- Bradycardia
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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
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#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
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3 causes of autonomic dysreflexia
- bladder issues/obstructions
- bowel blockages...fecal impaction
- skin issues
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How can skin issues cause autonomic dysreflexia?
- clothes are too tight
- look for irritations like pimples, boils, pressure sores, in grown toenails
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Medications to treat autonomic dysreflexia
- Nifedipine sublingual
- Apresoline IV
- Hyperstat
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