Spinal Cord Injury
cervical cord injury - diagnostic
ABGs electrolyte, glucose, hematocrit and hemoglobin levels urinalysis
diagnostic of SCI
MRI CT comprehensive neurological assessment
when is oral feeding contraindicted
NG - NJ percutaneous endoscopic gastrostomy
risk of paralytic ileus in first 48-72 hours
NG insertion careful monitoring of fluid and electrolytes fluid initiated when bowel control
sluggish blood flow can increase the risk of...
VTE
guillain barre
acute, rapidly progressing polyneuritis affects PNS symmetrical ascending paralysis
initial interventions
airway and oxygen control bleeding foley? two large bore catheters of infuse NS or LR
ongoing management
anticipate intubation if absent gag reflex and resp functional decline keep patient warm monitor
spinal shock manifestations
autonomic dysreflexia
areflexic neurogenic bladder (autonomous, flaccid, lower motor neuron)
bladder acts as if all motor functions are paralyzed, fills without emptying
syndromes: incomplete lesions
central cord syndrome anterior cord syndrome brown sequard syndrome posterior cord syndrome conus medullaris and cauda equina syndrome
loss of sympathetic tone
chronic low BP with possible postural hypotension
blunt injury
compression, flexion, extension, or rotational injuries to spinal column
primary injury
cord compression by bone displacement, tumour or abscess or interruption of blood supply to cord
reflexic neurogenic bladder causes (spastic, uninhibited, upper motor neuron)
corticospinal tract lesions, observed in spinal cord injury, stroke, multiple sclerosis, brain tumour, brain trauma
sensory neurogenic bladder causes
damage to sensory limb of bladder spinal reflex arc, observed in multiple sclerosis, diabetes mellitus
ex of blunt injury
diving, falls, motor vehicle accidents, pedestrian accidents
mechanism of injury
flexion injury hyperextension injury compression fracture
ex of penetrating injury
gunshot, stab wounds
neurological shock
hypotension, bradycardia, dry, flushed skin
other clinical manifestations of SCI (seocondary)
integument thermoregulation metabolic needs peripheral vascular conditions
sensory neurogenic bladder
lack of sensation of need to urinate
level of injury - neurological level
lowest segment of SC at which sensory and motor functions are both normal
3 classifications of injury
mechanisms of injury skeletal and neurological level of injury degree of injury
reflexic neurogenic bladder
no inhibition influence time and place of voiding, bladder empties in response to stretching of bladder wall
which nervous systems does autonomic dysfunction impact
parasympathetic and sympathetic
neuropathic pain
paresthesia, burning, shoting, stabbing worse at night interfere with appetite and sleep
potential respiratory dysfunctions
pneumonia and atelectasis
clinical manifestations of SCI (primary)
respiratory cardiovascular urinary GI
rehabilitation and home care considerations
respiratory rehab neurogenic bladder neurogenic bowel
guillain barre results on the PNS
results in segmental demyelination, edema, and inflammation of affected
immediate intervention for autonomic dysreflexia
sitting position remove stimulus call HCP if signs and symptoms don't improve
penetrating injury
stretched, torn, crushed, or lacerated spinal cord
S&S od autonomic dysreflexia
sudden onset of acute headache elevation of BP sweating above lesion congestion
initial goals of SCI
sustain life prevent further cord injury emergency management
symptoms of guillain barre
symmetrical muscle weakness distal paresthesia absent deep tendon reflexes ascending pattern
cardiovascular instability
symptomatic bradycardia related to unopposed vagal response low sympathetic tone sluggish blood flow hypotension
acute intervention
temperature control stress ulcer prophylaxis sensory deprivation bowel and bladder management reflexes
Secondary to hemorrhage
tissue hypoxia
secondary injury
vascular dysfunction edema ischemia electrolyte shifts inflammation free radical formation apoptotic cell death
level of injury - skeletal level
vertebral level where damage to vertebral bones and ligaments is most extensive
autonomic dysreflexia
visceral stimulation post resolution of spinal shock in patient with spinal cord lesions
when is autonomic dysfunction often seen
with muscle involvement and respiratory muscle paralysis