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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
CX of SCI:
- respiratory failure
- autonomic dysreflexia
- spinal shock
- further cord damage
COMMON vertebrae involvement:
- cervical: C5, C6, C7
- thoracic: T12
- lumbar: L1
TRANSECTION OF THE CORD:
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.
SPINAL CORD SYNDROMES IN INCOMPLETE INJURY:
- 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.
Assess of SC injury:
- -injury between C1 and C8.
- -paralysis involving ALL extremities
- -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.
LUMBAR AND SACRAL injuries:
- *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
INT during hospitalization:
- 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 AND NEUROGENIC SHOCK:
- 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
- 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!
- *sudden onset, severe, throbbing pain
- *severe hypertension and bradycardia
- *flushing above the level of injury
- *pale ext below the level of injury
- *nasal stuffiness
- *dilated pupils or blurred vision
- *piloerection (goose bumps)
- *restlessness and a feeling of apprehension
- -raise HOP (fowler's)
- -loosen tight clothing
- -check for bladder distention and noxious stimuli
- -give antiHTN meds
- -DOC: occurrence, tx and response