spinal cord injury 6

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spinal cord injury 6
2013-03-09 18:49:26
spinal cord injury

rosen & karpatkin 2013
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  1. optional sensory testing in addition to ASIA's 28 points
    • position sense
    • awareness of deep pressure/deep pain
    • recommended to use sensory scale - absent, impaired, normal
    • suggested to only use one joint per extremity
  2. how to eval muscles btwn T2 and L1?
    can't test them segmentally, so instead we make an assumption -- if there's function above and no function below we look at sensation in thorax and guess the motor is at the same dermatome
  3. whta's the rule on not stretching to increase ROM?
    • don't do it unless it's functionally¬† helpful! you don't want to make someone lose their tenodesis
    • also, never stretch lumbar fascia in low back bc that tightness helps pt sit upright... instead, stretch the hammies
  4. working on ROM, what should you do w hip flexion?
    don't stretch past 90 degrees bc it gets noxious for the back
  5. how to grade tone
    • test it by giving a quick stretch to hip adductors, knee flex, elbow ext
    • graded as zero, mild, mod, severe
  6. modified ashworth scale
    • measures muscle tone
    • 0 = no increase in tone
    • 1 = slight increase w catch and release or min resistance at end of ROM
    • 1+ = catch followed by resistance thru rest of ROM
    • 2 = marked increase in tone, but movable
    • 3 = considerable increase in tone, PROM is difficult
    • 4 = rigid
  7. basic halo precautions (tho they'll vary by location & MD)
    • have wrench w halo at all times (but out of reach of pt)
    • vest must fit
    • check w MD for amount of activity permitted
    • don't stress across cervical spine
    • avoid forward flexion and head, neck, trunk rot

    review slides (pg 70) for kessler's rules
  8. what -graphy is used to look at the cord
  9. minerva brace
    hard chest support going up to a helmut and a firm chin support
  10. SOMI - sthads for what?
    • sub occipital mandibular immobilizer
    • chest to chin support

    this would be great for sleeping on planes - keeps your head in one place, so you wouldn't wake up with a kink in your neck
  11. philadelphia collar
    does traction on neck - looks like a thick necklace, lifting the chin and holding the head in place
  12. risks of the halo
    • pin loosening
    • heigene
    • loss of ROM at shoulders & TMJ
    • change in body schema 2/2 elevated CoG
    • axial musle atrophy
    • axial joint contracture
    • but... has best outcome, and aside from head pos allows lots of mobility, while other alternatives leave pts bed-bound
  13. cervical collars - pros and cons
    • less restrictive than halo, but also therefore less stabilizing
    • serves as a reminder
    • gives warmth
    • "transitional:
    • but, soft collars can be ineffective
  14. what's a Kendricks Extrication Device
    • altrernative to cervical stabilazation board
    • semi-rigid brace that immobilizes trunk & C-spine
  15. why might an SCI pt get a NG tube
    to avoid aspiration of vomit secondary to paralytic ileus (intestinal paralysis)
  16. some acute cardiovascular complications that might plague a quad
    • spinal shock (hypotension, bradycardia, paralytic vasodilation)
    • neurogenic shock (hypotension 2/2 sudden disruption in neuro functin (autonomic pathways) --> blood pools in dependant areas)
    • hypovolemic shock (rapid thready pulse, nausea, increased then decreased BP)
    • intubation or ventilation w air-mask-bag
    • ventilation, oxygenation, circulation
  17. what happens to an SCI w neurogenic shock
    • hypotension secondary to sudden disruption in neuro function (autonomic pathways)
    • blood pools in dependant areas
  18. 3 basic aims of immediate med/surg treatment for SCI
    • treatment of initial trauma (shock)
    • reduction and stabilization of fx/dislocation
    • care of associated injury

    but really, at first it's just a matter of keeping the pt alive, and only when that's under control start addressing this other stuff
  19. hypovolemic shock
    rapid thready pulse, nausea, increased then decreased BP
  20. myelography def
    a type of x-ray that uses a contrast medium to detect pathology of the spinal cord
  21. epidurography
    x-ray of epidural space (can see meningeal damage)
  22. discography
    film of vertebral disc w contrast
  23. basic goals of the Halo vest
    realign the bony fragments in the C-spine & reduce dislocation
  24. 3 types of traction to use on SCI pts who are immobile
    • crutchfield tongs
    • Vinke tongs
    • Gardner-Wells tongs
  25. 3 options for cervical traction for a mobile SCI pt
    • Halo Ring traction
    • minerva jacket
    • SOMI (sub occipital mandibular immobilizer)
  26. thoracolumbar bracing cons
    2 injuries that need surgery
    best way to get to rapid mob
    • not as effective in preventing motion as C-spine bracing
    • if ligamentous injury or fx, surgery needed
    • if neurodeficit, surgery necessary
    • rapid mobilization best w surgery
  27. 4 kinds of thoracolumbar braces
    • body jacket (clamshell)
    • Jewet type 3-point brace -- frame all around torso
    • Boston brace (scoliosis)
    • semi-rigid support with shoulder straps
  28. elements involved in conservative SCI management, per Dr. Guttman
    • postural reduction w regular turning
    • pillow packs -- gives no contact at ITs, feet in DF, arms pos to limit contracture, reduced wt bearing on vulnerable spots
    • Stryker Frame on beds to decrease bedsores
    • "Roto Rest"
    • traction & manipulation
  29. 5 types of fancy beds
    • Stryker frame - holds you in and shifts angles
    • Circo-electric bed - for burns and SCI - rotates a few degrees every so many min, doing a full 360
    • Roto-rest - hi-tech stryker
    • Clinitron bed - beads & heat
    • air, water, floatation mattresses

    BUT, Karpatkin poopoos these, saying you can save a ton of money, not give the pt a crazy disorienting bed, turn the pt frequently, and have the same results
  30. hypovolemic shock
    • an emergency condition in which severe blood and fluid loss make the heart unable to pump enough blood to the body.
    • This type of shock can cause many organs to stop working.