BMS Spinal Cord Injury

Complete and Incomplete

What are the two types of spinal cord injuries?

Complete Spinal Cord Injury

Complete separation of upper and lower portion, everything below the level of injury is damaged

Incomplete Spinal Cord Injury

Partial parts at place of spinal cord injury have been damaged; some things altered

Primary and Secondary

What are the types of injuries?

Primary Injury

Related to the initial injury/damage

Secondary Injury

Worsens the injury after the initial injury

• Hemorrhage

• Ischemia

• Impaired tissue perforation from shock

• Hypovolemia

• Local Edema

What can a secondary injury be?

Depends on where in the spinal cord the injury occurred

What determines the level of injury?

The more problems occur bc it affects mostly below that level

The higher the SCI injury….

-plegia

Paralysis

-paresis

Weakness

Tetra- (aka quadri-)

Level C4-C6 (cervical-thoracic); all four limbs damaged

Para-

Below C6 (lumbar-sacral); just legs

Respiratory; nerves there innervate diaphragm and person can’t breathe

What is compromised at the level of C3-C5?

Complete loss vs. hyper-/hypoesthesia

What type of sensations can you have with SCI?

Hyper-/hypoesthesia

Overactive or dull sensation

• CT or MRI of spine

• X-ray

• CMP (or BMP) and CBC (baseline)

What are the diagnostics/labs that can be used to diagnose SCIs?

• Young males

• Trauma

• MOTOR VEHICLE CRASHES (MVCs)

• FALLS

• Acts of Violence (gunshot wounds)

• Sports

• Recreational activities (alcohol or illicit drug use)

Who is at risk for SCIs?

• Not engage in risk-taking behaviors

• Wear protective gear/equipment for potentially traumatic sports or recreational activities

• Wear seatbelts while operating a motor vehicle

• AVOID IMPAIRED DRIVING (ALCOHOL, MARIJUANA, OTHER)

• Avoid diving in shallow water (at least 9ft)

What should you educate patients to prevent SCIs?

• Bradycardia

• HYPOTENSION

• hypothermia

• Potential for cardiac dysrhythmias

What are the CARDIOVASCULAR S/S of spinal cord injury?

>90 mmHg; keeps adequate perfusion to spinal cord

What should the SBP be for cardiovascular SCIs?

• Difficulty breathing related to paresis or plegia of diaphragm (C3-5)

• Difficulty clearing secretions

What are the RESPIRATORY S/S of spinal cord injury?

Loss of bowel control

What are the GASTROINTESTINAL S/S of spinal cord injury?

Loss of bladder control

What are the GENITOURINARY S/S of spinal cord injury?

• Loss of movement (plegia vs. paresis)

• Numbness, tingling or loss/change to sensation in extremities (hypo/hyperesthesia)

• Unsteady gait

• Pain or pressure in the head, neck, back

What are the NEUROMUSCULAR S/S of spinal cord injury?

Changes in sexual function

What are the PSYCHOSOCIAL S/S of spinal cord injury?

ABCs (Airway, Breathing, Circulation)

What is the PRIORITY care for any patient?

Respiratory assessment

What assessment should you do on a patient with C3-5 injury?

Cervical collar

What should be placed on ALL suspected or confirmed SCIs?

Stabilize spine in neutral alignment

What does a cervical collar do?

• HR

• BP

• Peripheral perfusion (pulse strength and cap refill)

• HEMORRHAGE (hypovolemia, hypotension)

• FREQUENT GCS

• Sensory perception (Spinal Shock Syndrome)

What should you assess for SCIs?

Cognitive impairment can be indication of other injuries or substance abuse

Why should you preform FREQUENT GCS on a patient?

Spinal Shock Syndrome

Complete, although temporary, loss of motor, sensory reflex, and autonomic function; can last from 48h-weeks

• Log roll patients

• Keep cervical collar on until cleared by HCP

• Helps keep patient’s spine in neutral alignment

What spinal precautions can you take as a nurse to care for a patient with SCIs?

• Atropine sulfate (Isopto Atropine)

• IV meds to raise BP

• Midodrine (ProAmatine: Oral (PO)

• PPIs (-prazole)

• Muscle Relaxer (baclofen, methocarbamol)

• Fluids (IV or PO)

What are the MEDICATION treatments for SCIs?

Bradycardia

What does Atropine sulfate (Isopto Atropine) do?

Treat SEVERE Hypotension

What do IV meds to raise BP do?

Mild hypotension

What does Midodrine (ProAmatine: Oral (PO)?

Prevent stress ulcers

What do PPIs do?

Prevent muscle spasticity or pain

What do muscle relaxers do?

Hydration

What do fluids (IV or PO) do?

• Many types of spinal surgeries

• Priority STABILZE spine

• Postop care depends on level of injury and specific surgery completed

• Orthosis (brace) while body heals

What are SURGICAL treatments of SCIs?

• Immobilization of the spine with specific orthosis (brace)

• Monitor skin integrity

What are NON-SURGICAL treatments of SCIs?

• Cervical collar

• Halo crown

• Thoracic-lumbar sacral orthosis (TLSOs)

What are the types of orthosis?

• Respiratory

• Mobility

• Cardiovascular

• Integumentary (pressure injury)

• Genitourinary (straight Cath)

• Gastrointestinal

• Venous Thromboembolisms

What are the complications of SCIs?

• Assess skin

• Padding at bony prominences

• Turning patient frequently

• DVT, PE prophylaxis

How should you treat patient’s with immobility?

Autonomic Dysreflexia

What is a SERIOUS GI, GU, or vascular SCI complication that can occur?

Autonomic Dysreflexia

Potentially life-threatening HYPERTENSIVE EMERGENCY

Severe, sudden increase in BP puts patient at risk of HEMORRHAGIC STROKE

Why is autonomic dysreflexia life-threatening?

• FLUSHING and PROFUSE SWEATING above level of injury

• Blurred vision, spotty vision

• Nasal congestion

• SEVERE, throbbing headache

• Bradycardia

What are S/S of Autonomic Dysreflexia?

GU, GI, vascular stimulation

• UTI

• Full bladder

• Fecal impaction

• Bowel distention

• Irritation of hemorrhoids

• Pain

• Circumferential constriction (tight clothing)

• Excess pressure (sharp or hard objects)

What causes autonomic dysreflexia?

• Sit patient upright

• Remove stimulus (ex straight cath pt with full bladder)

• Treat BP, pain

What are treatments of autonomic dysreflexia?