Spinal cord injuries

what is a complete spinal cord injury

damage to spinal cord that eliminates all innervated below the level of injury

what is an incomplete spinal cord injury look like

some function below the level of injury

what causes hyperflexion

car hits a tree

what causes hyperextension

car is hit from behind

what is axial loading

sudden and extreme vertical spinal compression

what are the most common spinal cord injuries

cervical

what is the most common level for paraplegia

T12 and L1

what is central cord syndrome

motor weakness is greater in upper limps than lower limbs

what is anterior cord syndrome

loss of motor pain and temp but intact vibration and position sense

what is Brown-Sequard syndrome

Ipsilateral motor/proprioception loss and contralateral pain/temp loss

what is posterior cord syndrome

loss of proprioception but intact motor/pn/temp

what is the standard system used to classify SCI

American spinal injury association

what does an x ray show for SCI

identify type and what level of vertebrae the injury occurred

what does a CT scan assess for in SCI pts

hematomas, cord compression, or edema

what does an MRI do for SCI pts

detects full extent of injury

what injury results in T6 injuries and above

neurogenic shock

what is seen with neurogenic shock

hypotension, bradycardia, hypothermia

what injury causes respiratory compromise

C3-5

what do you see in respiratory compromise

very shallow resps and increased ETCO2

what injury affects intercostal muscles

T1-11

why is it bad if intercostal muscles are affected in a SCI

limits chest expansion

what injury affects abdominal muscles

T7-12

what happens if abdominal muscles are affected

ineffective coughing ability/airway clearance

what injury affects the bowel and bladder

S3

what is neurogenic bladder

inability to sense the need to go resulting in incontinence or retention

what puts a SCI pt at risk for paralytic ileus and when can it set in?

within 72 hrs of spinal shock

if the SCI is cervical what should you expect

INTUBATION

what nursing intervents are done with immobilization

C collar, log roll, Gardner-Wells tongs

what are gardner well tongs

cervical traction

what is given to prevent neurogenic shock

LR, Dopamine, and Norepi

why is methylprednisone used in SCIs

reduce inflammation, increase perfusion, decrease risk of 2ndary injury

how is orthostatic hypotension prevented

abd binder and compression stockings

what limitations are in play for halo external fixation devices

no bending at hips and halo rings attach to torso vest for complete immobility

how often can a cath be in place for intermittent catheterization

no more than q 6 hrs

why are anticholinergics used in SCIs

relax bladder muscles and ease urinary frequency

what is spinal shock

immediate loss of reflexes below injury

what does spinal shock look like

flaccid paralysis, areflexia, and absent sensation

what is neurogenic shock

loss of sympathetic response

what is autonomic dysreflexia

exaggerated vasoconstriction to a trigger

what injuries are autonomic dysreflexia seen in

above T6 after spinal shock resolves

what triggers autonomic dysreflexia

bladder distention, fecal impaction, tight gown or slippers

what are s/s of autonomic dysreflexia

severe HTN, bradycardia, headache, flushing above injury, pallor below injury

what interventions are used for autonomic dysreflexia

sit in high fowler’s, check bladder/bowel, antihypertensives it persists

what meds are used to treat presistent hypertension

sodium nitroprusside

what complications are trying to prevent in SCIs

pressure ulcers, DVT, UTI, contractures