Spinal Cord Injury

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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


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