Ch 65 SCI

Chapter Overview

• Focus on Peripheral Nerve and Spinal Cord issues

• Detailed exploration of Spinal Cord Injury (SCI)

Spinal Cord Problems

• Definition: Trauma or damage to the spinal cord that results in dysfunction.

• Statistics:

  • 17,000 new SCIs annually in the United States

  • 282,000 people currently living with an SCI

  • Increased mortality and decreased life expectancy

  • 30% rehospitalization rate

Types of Injury

Primary Injury

• Caused by direct trauma (blunt/penetrating).

• Examples include spinal cord compression from:

  • Bone displacement

  • Blood supply interruption

  • Traction on the cord

• Can also be due to penetrating wounds resulting in tearing or transection of the cord.

Secondary Injury

• Ongoing damage that follows primary injury, leading to permanent damage.

• Pathophysiology:

  • Begins minutes after injury and continues for months.

  • Edema occurs, leading to compression and ischemia.

  • Permanent damage can occur within 24 hours of edema development.

Classification of SCI

• Mechanisms of Injury:

  • Flexion

  • Flexion-rotation (most unstable)

  • Hyperextension

  • Vertical compression

  • Extension-rotation

  • Lateral flexion

• Degree of Injury:

  • Complete: Total loss of sensory and motor functions

  • Incomplete: Mixed loss with some functional preservation

Incomplete Injuries

• Cauda Equina Syndrome:

  • Results from damage to lumbar and sacral nerve roots, causing symptoms like:

    • Asymmetrical weakness

    • Flaccid paralysis

    • Loss of sensation

    • Areflexic bladder and bowel

Clinical Manifestations

Respiratory System

• Complications based on injury level:

  • Injury above C3: Total loss of respiratory function.

  • C3-C5: Respiratory insufficiency; requires intubation.

  • Cervical/thoracic injuries can cause ineffective cough leading to:

    • Aspiration

    • Atelectasis

    • Pneumonia

Cardiovascular System

• Injury above T6 can lead to:

  • Neurogenic shock (bradycardia, hypotension).

  • Hemorrhagic shock may exacerbate symptoms.

Urinary System

• Neurogenic Bladder: Abnormal bladder function leading to:

  • Overactive detrusor or sphincter muscles

  • Urinary retention/incontinence.

Gastrointestinal System

• Neurogenic Bowel: Loss of voluntary control leading to:

  • Constipation

  • Incontinence

  • Risk of ileus or megacolon.

Integumentary System

• Risk of skin breakdown due to:

  • Decreased sensation

  • Pressure injuries leading to infection.

Diagnostic Studies

• Imaging:

  • CT scans preferred for injury location.

  • MRI for soft tissue and neurological conditions.

• Comprehensive neurologic assessment essential.

Interprofessional Care

Prehospital Care

• Main focus on airway, breathing, circulation (ABCs).

• Immediate Goals:

  • Ensure airway integrity

  • Circulatory volume maintenance

Acute Care

• Emergency management including monitoring vital signs, supporting CB, and assessing injury extent.

• Interventions for hemodynamic stability noted for initial care and stabilization.

Rehabilitation

• Addressing complications like respiratory dysfunction and cardiovascular instability.

• Maximizing nutritional management is crucial for recovery.

Pain Management

Nociceptive Pain

• Management includes anti-inflammatory drugs and opioids.

Neuropathic Pain

• Occurs post-SCI; management includes:

  • Antiseizure medications

  • Relaxation therapy hinges on education about pain triggers.

Skin Care

• Risk of pressure injuries necessitates:

  • Routine skin assessments

  • Repositioning every 2 hours.

Neurologic Recovery

• Reflex returns may complicate rehabilitation, leading to issues like autonomic dysreflexia if spinal shock resolves.

Autonomic Dysreflexia (AD)

• A life-threatening condition characterized by:

  • Severe hypertension

  • Bradycardia

• Triggered primarily by bladder distention or rectal impaction, requiring immediate intervention.

Sexuality and Relationships

• Addressing sexual health and function is essential for psychosocial support post-SCI.