spinal chord injury part 2

Understanding conduction between upper motor neuron in the brain and lower motor neuron in the spinal cord.
Focus on the disconnection (nerve disruption) below the level of injury.

Defined as:
- A temporary condition following spinal cord injury, characterized by:
- Flaccid Paralysis: The muscles are unable to contract, leading to weakness and inability to move.
- Loss of Reflexes: Reflex actions below the level of injury do not occur.
- Loss of Sensation: Sensory loss in body parts below the level of injury.
Duration: Can last from 48 hours to several weeks, may become permanent if the injury is complete.
Symptoms of Spinal Shock:
- Paralysis below the level of the injury.
- No sensation in the affected area.
- Weakness due to loss of reflexes.

Definition: Shock caused by the disruption of nerve impulses from the spinal cord affecting vital functions.
Affects:
- Heart Rate: Can result in bradycardia (slow heart rate).
- Blood Vessels: Results in hypotension (low blood pressure), as the muscles controlling blood vessels become weak.
- Intestinal Movement: Causes issues such as paralytic ileus (lack of movement in the intestine).
Symptoms of Neurogenic Shock:
- Bradycardia
- Hypotension
- Severe constipation due to paralytic ileus.

A condition in which the intestine does not contract to move food through the digestive tract due to lack of nerve impulses.

Initial Post-Injury Phase:
- Flaccidity: Muscles are weak and lack tone immediately after spinal cord injury.
Recovery Phase:
- Potential transition to Spasticity: Muscle tone increases, leading to muscle rigidity and spasms.
Spasticity: Characterized by excessive tension in the muscles making movement difficult.

When moving patients with spasticity:
- Avoid grasping muscles: Hold at the joints to prevent precipitating muscle spasms.
- Use palms to support the joints above and below the affected muscles.

Muscle Relaxants:
- Baclofen: Commonly prescribed for muscle rigidities.
- Cyclobenzaprine (Flexeril).
Other medications include:
- Gabapentin
- Pregabalin
Corticosteroids: Such as Methylprednisolone, used to decrease inflammation and edema in spinal cord injuries.

Dopamine: Utilized to stimulate heart function and increase blood pressure.
Mannitol: A hypertonic solution used to decrease edema and promote diuresis.

Mechanism:
- Mannitol acts as a hypertonic solution drawing water into the blood vessels from surrounding tissues, thus reducing tissue edema.
- Osmotic Pressure: Fluid movement from low to high osmotic pressure.

Defined as an exaggerated autonomic response due to spinal cord injuries at or above T6.
Symptoms:
- Severe hypertension due to vasoconstriction.
- Severe headache and flushing above the injury level.
- Skin responses: Sweating and goosebumps.
Common triggers include:
- Distended bladder
- Fecal impaction
Treatment Protocol:
- Initial response: Position patient sitting to manage hypertension.
- Assess bladder for possible catheterization to relieve urinary retention.

Definition of Neuropathic Pain: Pain resulting from nerve damage, often experienced in spinal cord injuries.
Common medication includes:
- Gabapentin
- Pregabalin
Conditions associated with neuropathic pain include:
- Shingles (herpes zoster)
- Trigeminal neuralgia
- Diabetic neuropathy

Educate families about potential complications and management strategies, particularly around spasticity.
Emphasize the importance of monitoring for autonomic dysreflexia and the need for quick intervention.

Review autonomic dysreflexia and its management as it frequently appears in examinations. Additionally, correlate spasticity management with appropriate medications and handling techniques.