Spinal Cord Injury

• injury to the SC causes partial or complete disruption of the nerve tracts and neuron.
• the injury can involve contusion, concussion or lacerations of the cord.
• (+)spinal cord edema; necrosis of the SC can develop as a result of compromised capillary circulation and venous return.
• (+)LOSS of motor, sensory, reflex activity, and bowel and bladder control
• MOST COMMON CAUSE: motor vehicular accident, falls, sporting and industrial accidents and gun shot and stab wounds

• respiratory failure
• autonomic dysreflexia
• spinal shock
• further cord damage
• death

• cervical: C5, C6, C7
• thoracic: T12
• lumbar: L1

1. COMPLETE- the SC is severed completely, with TOTAL loss of sensation, movement and reflex ability below the level of injury

2. INCOMPLETE/PARTIAL- SC is severed and damaged partially; early tx is needed to px partial damage from developing into complete permanent damage.

• 
• 1. CENTRAL CORD SYNDROME:
• -occurs from a lesion in the CENTRAL PORTION of the SC.
• -loss of motor is more pronounced in the upper ext, and varying degrees and patterns remain intact.
• 2. ANTERIOR CORD SYNDROME:
• -damage: anterior portion of the gray and white matter of the SC;motor fxn, pain and temperature sensation are LOST below the level of injury; sensation of vibration, position and touch remain intact.
• 3. POSTERIOR CORD SYNDROME:
• -damage: the posterior white and gray matter of the SC.
• -motor fxn remain intact, but the pt experiences a loss of vibratory sense, crude touch and position sensation.
• 4. BROWN-SEQUARD SYNDROME:
• -results from penetrating injuries that cause hemisection of the SC or injuries that affect half the cord
• -motor fxn, vibration, proprioception, and deep touch sensation are lost on the same side of the body (ipsilateral) as the lesion or cord damage.
• -on the opposite side of the body (contralateral) from the lesion or cord damage, the sensation of pain, temperature, and light touch are affected.
• 5. CONUS MEDULLARIS SYNDROME:
• -damage to the lumbar nerve roots and conus medullaris of the SC
• -(+) bladder and bowel areflexia
• -flaccid extremities
• -(+)damage to the UPPER SACRAL of the SC=erection and micturition will remain.
• 6. CAUDA EQUINA SYNDROME:
• -injury to the LUMBOSACRAL NERVE roots below the conus medullaris
• -(+) areflexia of the bowel, bladder and lower reflexes.

• TETRAPLEGIA
• -injury between C1 and C8.
• -paralysis involving ALL extremities

• PARAPLEGIA
• -injury bet T1 and L4.
• -paralysis ONLY at LOWER extremities

• *injury C2 to C3 is usually fatal
• *C4-major innervation to the diaphragm by the phrenic nerve.
• *injury above the C4 causes resp difficulty and paralysis of all extremities
• *injury at C5 to C8- (+)movement in the shoulder, may also have decreased resp reserve

• *loss of movt of the chest, trunk, bowel, bladder and legs may occur, depending on the level of injury.
• *leg paralysis may occur
• *autonomic dysreflexia with lesion or injuries above T6 and in cervical lesions may occur.

• *loss of movt or sensation of the lower extremities may occur
• *S2 and S3 (center of micturition; bladder will not contract but not empty.
• *injury above S2 in males-may have an erection but cannot ejaculate (sympathetic nerve damage)

• -assess airway
• -maintain patent airway
• -px: head flexion, rotation and extension
• -maintain an extended position
• -logroll the pt
• -NO PART OF THE BODY SHOULD BE TWISTED AND TURNED, and the pt is not allowed to assume a sitting position
• -CERVICAL FRACTURE-immediately place pt in skeletal traction via skull tongs or halo traction to immobilize the cervical spine and reduce fracture and dislocation

• I. RESP SYSTEM:
• -monitor ABG levels and maintain mechanical ventilator as prescribed to px resp arrest
• -use incentive spirometer and do deep breathing
• -monitor for signs of infection (pneumonia)

• II. CARDIOVASCULAR SYSTEM:
• -WOF cardiac dysrhythmias
• -assess for signs of bleeding and hemorrhage at fracture site
• -WOF shock (hypotension, tachycardia, a weak and thready pulse)
• -assess lower ext for DVT
• -measure calf and thigh to identify increase in size
• -remove antiembolism daily stocking to assess skin
• -monitor for orthostatic hypotension when repositioning the pt.

• III. NEUROMUSCULAR SYSTEM:
• -assess NS
• -assess motor and sensory status to determine level of injury
• -assess motor ability: squeeze hands, spread fingers, move toes, turn feet
• -assess sensation: pinching skin or pricking it with a pin starting from the shoulders and working down to the lower ext.
• -WOF signs of AD and signs of shock
• -immobilize pt
• -assess and reduce pain, analgesics as prescribed

• IV. GIT SYSTEM:
• -assess abdomen for distention and hemorrhage
• -monitor for bowel sounds and paralytic ileus
• -px bowel retention
• -initiate bowel control
• -adequate nutrition and high fiber diet

• V. RENAL SYSTEM:
• -px urinary retention
• -initiate bladder control
• -maintain fluid and electrolyte balanced
• -OFI: 2000ml/day
• -WOF urinary infection and calculi

• VI. INTEGUMENTARY SYSTEM:
• -assess skin integrity
• -turn pt every 2 hours

• SPINAL SHOCK: complete but temporary loss of motor, sensory, reflex and autonomic fxn
• S/SX: HYPOTENSION, BRADYCARDIA

• NEUROGENIC SHOCK: common to pt with above T6 injury; experienced usually after injury. Massive vasodilation occurs, leading to pooling of blood in BV, tissue hypoperfusion, and impaired cellular metabolism
• S/SX: FLACCID PARALYSIS
• LOSS OF REFLEX ABILITY BELOW THE LEVEL OF INJURY
• BRADYCARDIA
• HYPOTENSION
• PARALYTIC ILEUS

• -also known as autonomic hyperreflexia
• -occurs after the spinal shock is resolved
• -occurs with lesions above T6 and cervical lesions
• -caused by: visceral distention frm a distended bladder or impacted rectum
• -EMERGENCY!!! tx ASAP!
• S/SX:
• *sudden onset, severe, throbbing pain
• *severe hypertension and bradycardia
• *flushing above the level of injury
• *pale ext below the level of injury
• *nasal stuffiness
• *nausea
• *dilated pupils or blurred vision
• *sweating
• *piloerection (goose bumps)
• *restlessness and a feeling of apprehension

• N/I:
• -raise HOP (fowler's)
• -loosen tight clothing
• -check for bladder distention and noxious stimuli
• -give antiHTN meds
• -DOC: occurrence, tx and response