3.2 Other SCI issues

Question 1

apneic bradycardia

Answer 1

• slow HR (rapid decrease) with some loss of breathing

- happens when we do tracheostomy cleaning

Question 2

stages of getting a tracheostomy

Answer 2

• first do oral intubation

- If it takes longer than 10-14 days to come off of the trach, they’ll do the tracheostomy hole through the throat

Question 3

Why would they do a tracheostomy instead for prolonged cases?

Answer 3

• oral intubation keeps the vocal cords open
• prolonged opening can cause scarring and voice change

*partial or complete paralysis

Question 4

cleaning secretions from trach

Answer 4

• long tube you can put down the trachea and suction things out
• bradycardia shouldn’t keep you from suctioning out

Question 5

problems with a trach (nerve)

Answer 5

• vagus nerve runs near it - might trigger a vagal
• response that creates issues with heart
• don’t actually know why

Question 6

bradycardia and trach

Answer 6

• just something that may happen, don’t freak out

- educate and monitor

Question 7

Where do autonomics leave the spinal cord?

Answer 7

about at T6

Question 8

injury below T6 and autonomics

Answer 8

wouldn’t affect autonomic nervous system

Question 9

injury above T6 and autonomics

Answer 9

lesions from T6 and above are at risk for autonomic dysreflexia

Question 10

What is autonomic dysreflexia?

Answer 10

• something below the level of the lesion throws off sympathetic and parasympathetic systems off
• body starts (somehow) perceiving sensation as noxious stimuli (they can’t feel it) and sends it up

Question 11

What can cause autonomic dysreflexia?

Answer 11

• could be caused by a kinked catheter, ingrown toenail, wrinkle
• Sometimes, could be due to bladder distention, UTI, bowel impaction

Question 12

BP and autonomic dysreflexia

Answer 12

• super high blood pressure

- may stroke out and die

Question 13

autonomic dysreflexia: do patients get this multiple times? Is it dangerous?

Answer 13

• most patients who experience it will get it multiple times

- life threatening issue for patients

Question 14

Where do s/s of autonomic dysreflexia start happening?

Answer 14

above the level of the lesion

Question 15

s/s autonomic dysreflexia

Answer 15

• sudden increase in BP
• pounding headache
• flushing and perfuse sweating
• drippy nose
• sweating and goosebumps below the lesion

Question 16

What should be done if a pt is showing s/s of autonomic dysreflexia?

Answer 16

• get help

- sit them up as soon as possible

Question 17

Why wouldn’t you lay a person down who is having autonomic dysreflexia?

Answer 17

• opposite of orthostatic hypotension
• If you lay them down, their BP will increase
• do a full body exam to figure out what’s going on

Question 18

thermoregulation: below the level of lesion

Answer 18

• below the level of the lesion, can’t sweat or shiver
• can’t feel temperature-wise
• no vasoconstriction/vasodilation

*typically cold

Question 19

thermoregulation: para vs. quad

Answer 19

• paraplegics can do ok because core mass can help regulate

- quads are usually in warm clothes year round

Question 20

thermoregulation and treatment considerations

Answer 20

• don’t want to treat them in a cold place

- burning a ton of calories to try to stay warm

Question 21

What type of lesions cause spasticity?

Answer 21

UMN lesions

Question 22

What can happen when patient repeatedly trigger spasticity to help control movement?

Answer 22

• can get myositis ossificans in their muscles from hitting them to trigger spasms
• lays down bone because it can’t heal tissue properly

Question 23

Can SCI pts get spasms in muscles they have no control over?

Answer 23

yes

Question 24

bad spasticity

Answer 24

• scissoring creates pressure on bony landmarks, bowel and bladder difficulty, transfers, etc
• If it’s really bad, will need med management

Question 25

What type of lesions cause flaccidity?

Answer 25

LMN lesions

Question 26

problems with flaccidity

Answer 26

- muscle wasting - joint laxity - contracture - hypomobile or hypermobile - osteoporosis - fractures - core muscles - dependent edema

Question 27

flaccidity: osteoporosis considerations

Answer 27

- lose bone mass (muscles no longer pulling on bones to strengthen) - also not WB - 1-1.5 years after injury, they typically lose 1/3 of bone mass

Question 28

flaccidity: core muscle concerns

Answer 28

- breathing - posture - digestion - can get kyphotic or scoliotic

Question 29

flaccidity: dependent edema

Answer 29

- don't have a muscle pump | - LE may have more swelling