Spinal Cord Injury

• Complete: no function below level of injury

• Incomplete: some function below level of injury

What is complete vs. incomplete spinal cord injury?

• Primary: related to initial injury

• Secondary: worses the injury

What are the two categories of spinal cord injury?

• Hemorrhage

• Ischemia

• Impaired tissue perfusion from shock

• Hypovolemia

• Local edema

What are the types of secondary spinal cord injury?

Where the injury occured, affects everything below

What does the level of injury depend on?

• -plegia: paralysis

• -paresis: weakness

What is -plegia vs. -paresis?

All four extremities

What does tetra- (aka quadri-) mean?

Just legs

What does para- mean?

RESPIRATORY COMPROMISE; nerves here innervate diaphragm and can paralyze all four extremities

What are patient at risk for when they have an spine injury at C3-C5?

• Sensation can either be fully lost

• Hyperesthesia: overactive sensation

• Hypoesthesia: low sensation

What does complete loss of sensation vs. hyper/hypoesthesia mean?

• CT or MRI of spine

• X-ray

• CMP (or BMP) and CBC

  • For baseline

What are the diagnostics for spinal cord injury?

• YOUNG MALES

• Trauma

• MVCs

• FALLS

• Acts of violence (gunshot wounds)

• Sports

• Recreational activities (alcohol or illicit drug use)

What are the RISK FACTORS for spinal cord injury?

• 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 (INCLUDING ALCOHOL, MARIJUANA, AND OTHER IMPAIRING SUBSTANCES)

• Avoid diving in shallow water (water must be at least 9FT)

What education should be given to PREVENT spinal cord injuries?

• Cardiovascular

  • Bradycardia, HYPOTENSION, hypotermia (diff. mantain)

  • Potential for cardiac dysrhythmias

• Respiratory

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

  • Difficult clearing secreations (aspiration, pneumonia)

• GI/GU

  • Loss of bowel/bladder control

• Neuromuscular

  • Loss of movement (plegia vs. paresis)

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

  • Immobility

  • Unsteady gait

  • Pain or pressure in head, neck, or back (acute injuries)

• Psychosocial

  • Changes in sexual function

What are the S/S spinal cord injury?

>90 MMGH to keep adequate perfusion to the spinal cord

What should the SBP be in spinal cord injuries?

• ABCs priority

• C3-5

  • RESP ASSESSMENT

  • CERVICAL COLLAR on ALL suspected or confirmed SCIs (neutral alignment keeps resp. collapse)

• Evaluate: HR, BP, and periphral pulses (pulse strength and cap refill)

• Assess for HEMORRHAGE (hypovolemia)

• FREQUENT GCS

  • cognitive impairment can be indication of other injuries or substance abuse

• Assess pt. sensory perception

  • SPINAL SHOCK SYNDROME (initial injury)

• SPINAL PRECAUTIONS

What is the initial care of SCIs?

• Low HBG/HCT

• Hypovolemia

• Low BP

• S/S

  • Frank bleed

  • Unexpected bruising

  • Black tarry stool

  • Red urine

What is the assessment for hemorrhage in SCIs?

Complete (but temporary) loss in motor and sensory relfex and autonomic function

• Lasts 48 hrs - weeks

What is SPINAL SHOCK SYNDROME?

• Log roll patients

• Keep cervical collar on until cleared by HCP

• Helps keep patient’s spine in neutral alignment

What are SPINAL PRECAUTIONS?

• Meds (does not FIX but helps alleviate SX)

• Surgical

• Non-surgical

What are the TX options for SCIs?

• Atropine sulfate (Isopto Atropine)

  • Tx symptomatic bradycardia

• IV meds to raise BP

  • Severe hypotension

• Midodrine (ProAmatine)

  • Oral (PO)

  • Mild hypotension

• PPIs (-prazole)

  • Stress ulcers

• Muscle relaxers (Baclofen and Methocarbamol)

  • Muscle spasticity or pain

• Fluids (IV and PO hydration)

  • hydration

What are the MEDS for SCIs?

• PRIORITY IS TO STABILIZE SPINE

• Post op care will depend on level of injury and specific surgery completed

• Patient will need to wear a specific orthosis (brace) while the body heals

What are the nursing interventons for surgical tx for SCIs?

• Immobilization of the spine with a specific orthosis (brace)

  • Ex. cervical collar, halo, throacic lumbar sacral orthosis (TLSOs)

• MONITOR SKIN INTEGRITY FOR ALL

What are the nursing interventions for non-surgical tx for SCIs?

• Respiratory

  • Difficult remove secretions, pneumonia

  • Tx: oxygenate

• Mobility

  • Pressure injury, DVT/PE risk

  • Tx: Turn, DVT prophylaxis, padding

• Cardiovascular

  • AUTONOMIC DYSREFLEXIA

• Integumentary

  • Skin breakdown

  • Tx: Turn, check

• GI/GU

  • Incontinence

  • Tx: straight cath, monitor I/O, BM

• Venous thromboembolisms

  • DVT/PE risk

  • Tx: monitor unilateral swelling, redness; DVT prophylaxis

Whta are the complications for each body system for SCIs?

Potentially life threatening HYPERTENSIVE EMERGENCY

What is AUTONOMIC DYSREFLEXIA?

HEMORRHAGIC STROKE FROM SEVERE, SUDDEN INCREASE IN BP

What is the MAIN risk of autonomic dysreflexia?

• FLUSHING AND PROFUSE SWEATING above level of injury

• Blurred vision, spotty vision

• Nasal congestion

• SEVERE, throbbing headache (Increased ICP)

• Bradycardia

What are the S/S autonomic dysreflexia?

GU and GI or vascular stimulation

• Examples

  • UTI

  • Full bladder

  • Hemorrhoids

  • Pain

  • Circumferential constriction of the body (tight clothes)

  • Excess pressure

  • Sharp or hard objects

What are the CAUSES of autonomic dysreflexia?

• SIT PATIENT UPRIGHT

• REMOVE THE STIMULUS (EX. STRAIGHT CATH PATIENT WITH FULL BLADDER)

• Tx the pt. BP

What is the TX for autonomic dysreflexia?