Spinal Cord Injury
Card Set Information
Spinal Cord Injury
Adult MedSurg 2
What is the major risk factor for traumatic brain injury (TBI)
Mechanism of Injury
: when immobile head struck
: head is moving and object it hit is still
Rotation injury when head twists as it hits
: Moving object hits immobile head which then hits second object
Types of TBI
--Brain actually moves inside skull as struck, as it's only tethered at the base
--Disruption to small blood vessels occurs as it scrapes the inside of the skull
--Velocity of object and fracture of bone creates the damage
--High velocity (bullets) produce shock waves
Coup-Contrecoup (Counterblow in French)
--Injury is to side opposite of the side hit
: adds pressure to brain
: at back of skull-->raccoon eyes.
: Short decrease in LOC, amnesia
: May be severe, will be localized
Diffuse Axonal Injuries
: small injuries all over the brain r/t anorexia, anemia, hypoxia, post cardiac arrest. May--> posturing (flexion/extension).
Decreased LOC is primary S&S
May present with posturing, increased ICP
What do you need to know about epidural hematoma?
Between skull and dura mater usually associated with skull fracture:
--Forms large clot, usually quickly (arterial)
--Unconscious immediately after HI
--Awakens with lucid interval
--LOC rapid deteriorates, needs prompt attention.
--Quickly becomes comatose
--Confirm with CT scan
--Prompt intervention is essential
Subdural Hematoma (blood collects between the dura mater and arachnoid mater)
: will cause bleeding in area of edema
--S&S appear 24-48 hours after injury
--Comprise ¼ of all TBI
--Onset of S&S is slower than Epidural Bleed
--May have variable change in LOC (fluctuates)
--HA, irritable and confused
: common with ETOH
--Occurs with atrophy, so more room for bleeding
--Appears recovered then gets hemiparesis, pupil changes
--Surgical evacuation with drains left in
Bleeding directly into parenchymal tissue of the brain
Can't be resected
From rapid reversal of ischemia
Cell wall damage from oxygen free radicals
Occurs after massive hypotension (like cardiac arrests or awaking from anesthesia)
Nuring care for Traumatic Brain injury
Airway, airway, airway
Protect cervical spine, keep ICP low
F&E, Elimination (IV lines, foley catheter)
Nutritional support (feeding tubes)
Some are surgically managed
Rehabilitation for nearly everyone.
Things to know about Spinal Cord Injuries
10,000 new injuries each year, males 16-30 most common
Auto, motorcycle, gunshot or knife wounds
Mechanisms of injury for spinal cord injury
Hyperextension (diver's fracture)
C1 (odontoid process) fractures
C2 (hangman's fracture)
Most common are C1-C2, C4-C5, T11-T12
Early cord edema can make exact location difficult to recognize (even reflexes are distorted)
Pathyphys of spinal cord injury
Rarely torn or transected by direct trauma
Due to cord compression by bone displacement, interruption of blood supply to cord, traction from pulling on cord
GSW and Stab wounds can cause tearing and transection
Primary injury- initial disruption of axons as a result of stretch or laceration
Rectal tone is a good diagnositc for spinal cord injury
Pathophys of secondary injury r/t spinal cord injury
Damage from ischemia, hypoxia, microhemorrhage and edema
Molecular level- cell death occurs, can continue for weeks or months after initial injury
Complete cord damage in severe trauma related to autodestruction of cord initial care and management critical to limit processes
Edema- can cause permanent damage within 24 hours, can develop secondary to inflammatory response, can compress cord and increase ischemic damage. Think about admin Decedron.
Extent of injury and prognosis for recovery most accurately determined at least 72 hrs or more after injury
SnSs of SCI
Autonomic dysreflexia with exaggerated ANS reflexes related to full bladder/bowel distention with massive HTN (vasoconstriction) fever,dilated pupils.
This is life threatening!!
Spinal Cord Shock
: hypotension, multiorgan destruction.
SnSs of spinal cord shock
Affects about 50% with acute SCI
Temporary neurologic syndrome lasting days to months.
Decreased reflexes below level of injury
Loss of sensation below level of injury
Flaccid paralysis below level of injury
May mask post injury neurologic function
Active rehab. may still begin
What is neuorgenic shock
Due to the loss of vasomotor tone caused by injury
Characterized by hypotension and bradycardia- important clinical clues
Loss of sympathetic nervous system tone innervation causes peripheral vasodilation, venous pooling, decreased cardiac output
Usually with cervical or high thoracic injury
Care for spinal cord injury?
Care at accident scene
Care in ED and radiology
Early hospital care
--Cardiovascular support (hypotension)
Possible nursing diagnosis?
Pretty much all of them
Management of constipation becomes important. Intervention is typically digital stimulation.
Nursing management for SCI pt.
Maintain airway, oxygenation, suction, ventilation
Immobilize spine- skeletal traction via tongs (Crutchfield or Gardner-Wells), halo traction
Monitor VS, fluid balance, neuro assessment
Prevent complications of immobility- rehab starts on admission- specialty beds
Medications- Methylprednisolone considered within 8 hours of injury possible neuro risks and potential risks
relieve edema- corticosteroids, anti-inflammatories
prevent discomfort- analgesics, sedatives, muscle relaxants
Prepare for surgery- possible decompressive laminectomy, spinal fusion
If SCI is suspected, DO NOT MOVE PT. WAIT FOR DR./ROTATION TEAM TO DO IT.