SCI

Question 1

What are the two things that determine spinal cord injury?

Answer 1

Mechanism of injury and location of trauma

Question 2

What is primary injury vs secondary injury?

Answer 2

Primary = result of initial trauma
Secondary = result of ischemic/hypoxia/hemorrhage that destroys nerve tissues

Question 3

For how long is secondary injury preventable for SCI?

Answer 3

first 4-6 hours after injury

Question 4

What are the 6 types of injury that can cause SCI?

Answer 4

• fractures
• dislocations/subluxations
• flexion injuries
• extension injuries
• compression injuries
• axial rotational injuries

Question 5

What type of injury is highly unstable and often occurs when patient falls on their head?

Answer 5

Axial rotational injuries

Question 6

What injury causes vertebral bones to shatter or burst, and often occurs with blow to top of head or landing forcefully on feet?

Answer 6

Compression injuries

Question 7

What injury is caused by backward bending of spinal column, e.g. fall when chin is point of impact?

Answer 7

Extension injuries

Question 8

What SCI injury is most common and is caused by forward bending of spinal column e.g. head struck from behind?

Answer 8

Flexion injuries

Question 9

What is quadriplegia defined by?

Answer 9

Patient with cervical level injury (C1-C7)

Question 10

What is paraplegia defined by?

Answer 10

patient with injury from thoracic level (T1-T12) through to sacral level (S1-S5)

Question 11

SCI Function varies depending on what?

Answer 11

vertebrae involved, e.g. injury to C1 vs injury to S5

Question 12

Intermediate interventions for SCI?

Answer 12

• ABC’s
• immobilise spine
• intubate/vent if needed

Question 13

ED interventions for SCI?

Answer 13

• give steroids
• monitor for neurogenic and spinal shock

Question 14

Example of an IV Corticosteroid used to treat SCI in ED?

Answer 14

Methylprednisolone

Question 15

Neuro interventions for stabilised SCI?

Answer 15

• halo traction
• spine fusion
• neck brace/collar
• assess q4h

Question 16

Respiratory interventions for stabilised SCI?

Answer 16

• trach care as needed
• lung sounds
• suctioning
• quad coughing

Question 17

Mobility interventions for stabilised SCI?

Answer 17

• active/passive ROM
• maintain body alignment
• increase HOB

Question 18

bowel/bladder function interventions for stabilised SCI?

Answer 18

• pt may initially have paralytic ileus, may use NG tube to decompress
• high fiber diet
• stool softeners
• bladder program
• intermittent cath q6h

Question 19

Describe the SCI complication spinal shock?

Answer 19

absence of voluntary and reflexive activity below level of injury, lasts days-months

Question 20

Describe the SCI complication neurogenic shock?

Answer 20

-hemodynamic phenomenon including loss of vasomotor tone
- occurs within 30 min of injury T5 or above
- lasts up to 6 weeks

Question 21

Symptoms of spinal shock?

Answer 21

• decreased reflexes
• loss of sensation
• flaccid paralysis below injury

Question 22

Symptoms of neurogenic shock?

Answer 22

• hypotension
• bradycardia
• poikilothermia

Question 23

Intervention for neurogenic shock?

Answer 23

• airway support
• fluids PRN
• atropine for bradycardia
• vasopressors for BP

Question 24

Describe the SCI complication autonomic dysreflexia?

Answer 24

excessive uncontrolled sympathetic response, usually from noxious stimuli, occurs with SCI above T6

Question 25

Symptoms of autonomic dysreflexia?

Answer 25

- severe HA - increase in BP - sweating - blurry vision - nausea - nasal congestion

Question 26

Interventions for autonomic dysreflexia?

Answer 26

- sit pt up - call MD - antihypertensives

Question 27

Describe the SCI complication spasticity?

Answer 27

Increase in reflex activity and spasms, triggered by movement, pain, bladder etc.

Question 28

Symptoms of spasticity?

Answer 28

muscle spasms, increased reflex activity

Question 29

Interventions for spasticity?

Answer 29

medication, rehab program e.g. exercise, stretching

Question 30

What antihypertensive medications could be used to treat autonomic dysreflexia?

Answer 30

NTG, Apresoline, Prazosin

Question 31

What medication could be used to treat spasticity?

Answer 31

Baclofen