Spinal Cord Injury

SPINAL CORD INJURY SPINAL CORD INJURY •

Possible causes: o MVC o Falls o Industrial accidents o Sporting activities

SPINAL CORD’S PURPOSE AND FUNCTION • •

Serves as a 2-way conduction pathway between brain and peripheral nervous system Contains the reflex centers for those activities which don’t require control by brain o Knee jerk: simple reflex arch

VERTEBRAL INJURIES •

Prevent cord damage

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Definition o Involve the vertebrae of the spinal column

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Fractures o Simple o Compressed o Communuted o Dislocation

SPINAL CORD INJURY •

Definition o Refers to injury of spinal cord itself o Usually associated with vertebral injuries o However, can result from an interruption of the cord’s blood supply

SIGNS AND SYMPTOMS – DEPEND ON •

Level of Injury o Cervical  Most common type; C2 – C3 injury is rapidly fatal  Complete transcection quadriplegia  Swelling tow segment above / below o Thoracic  Less frequent; requires violent injury transection – ribs protect  @ T12 – L1 Paraplegia o Lumbar Injury  L4-L5 most common – Hit or bending over o Sacral and Coccygeal  Usually result from falls or direct trauma; nerves somewhat protected SYMPTOMS OF LUMBAR – SACRAL INJURY  Flaccid paralysis of lower extremities  Loss of deep tendon reflexes  Urinary retention  Fecal Incontinence  Loss of sensation  Severe lower back pain

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Extent Of Injury o Concussion – Cord bump lose function o Contusion o Compression o Transection 

Complete – Loss of everything below lesion

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Incomplete – Varying degrees of loss; assess wk with remaining

o Laceration – Cutting cord; ischemia with cord tissue death o Hemorrhage – Due to trauma with ischemia of tissue •

Mechanism Of Injury o Hyperflexion – Neck down o Hyperextension – Neck up o Compression – Fall flat on feet / head

o Rotational Forces – Twisting neck

SPINAL SHOCK • • • • •

Occurs immediately after spinal cord trauma – Lasts from few days to months Cessation of all motor, sensory, reflex and autonomic functions below level of injury Everything shuts down Observe patient closely for Hypotension, Bradycardia, Hyperthermia and flaccid paralysis during the spinal shock stage Recovery occurs with return of some reflex activity o Anal wink: not shock

EMERGENCY MANAGEMENT •

Goals to preserve life and prevent further damage o At Accident Site  ABC’s, transportation o In Emergency Room  Assess, evaluate, obtain history, provide necessary support

MEDICAL MANAGEMENT •

Nonsurgical o Controlling cord edema  Medications • Ex. Solu-Medrol o Immobilization if a fracture present in addition to cord damage  Cervical • Tongs with traction • Halo device o Early mobilization

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Thoracic or Lumbar • Body casts • Positioning

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Sacral or Coccygeal • Bed rest • Girdles

Surgical o Spinal Cord Cooling  Not done a lot anymore because steroids  R/F infection. Irrigate with cool saline

o Laminectomy o Spinal Fusion o Harrington Rods

-Provide Stability -Paralysis will stabilize spine so have quality and  R/F complications

NURSING MANAGEMENT Goals: Prevent further injury Maintain intact functions Prevent complications Rehabilitation (Starts the minute the pt comes in) •

Disuse Syndrome

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Respiratory o  R/F Pneumonia o Injury above C4 o Respiratory status

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Cardiovascular o  R/F Thrombus, orthostatic HTN o No dangle b/c  R/F stroke; lay down o Pain, swelling, redness o TED, Lovenox

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Integumentary o R/F pressure ulcers, breakdown, and decreased sensation

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Musculoskeletal o Prevent contractures  ROM, Valium  Spaccidity major problems with quads  Loose Ca because increased stress bones muscle atrophy

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Nutrition o Fluid volume overload o Dehydration, NG, Keofeed  IV fluids  Bowel sounds  Gag/swallow reflex  Self care feeding devices

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Genitourinary Tract o Neurogenic Bladder o During spinal shock the bladder is atonic – MUST have a cath o As spinal shock subsides you will see one of two things with total cord transection  1-Upper Motor Neuron Bladder: Occurs above T12; bladder becomes hypertonic and spastic. • Bladder empties reflex • Bladder training because have reflex

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2-Lower Motor Neuron Bladder: At or below T12; bladder becomes atonic with increased bladder capacity • Large amount of urine – Leaking urine – need cath

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Bowel o Upper Motor Neuron  Bowel empties reflexively – Bowel training o Lower Motor Neuron  Loss of reflex action with external sphincter relaxation  Bowel incontinence; bowel training (enema, stimulation)

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Nervous System o Autonomic Hyperreflexia or Dysreflexia  Sit Up Immediately –  ICP and  BP • Occurs 6 years post injury • Flag Chart • Vasodilator because BP will bottom out  Occurs after spinal shock phase in patients with injury at or above T6  Very serious emergency  Results from distended bladder, distended bowel, skin (pressure, heat and cold) • Uninhibited response • Possible UTI’s  Signs and Symptoms: • Hypertension, H/A, Flushing, Sweating, Nasal congestion, bradycardia  Management • Key is prevention • Treatment consist of elevating the HOB and removing cause – speed is essential Safety o Increased R/F Injury

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Pain o o o o

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Sexuality o Males – Complete transactions - Primary area of concern  Upper Motor Neuron – C1 – T12; large percentage experience reflexogenic erections due to intact reflex arc.  Lower Motor Neuron - T12-S4; no reflex response; Small percentage able to experience psychogenic erections • Stimulates higher than brain levels

Comfort and Rest Pain at point of injury Addiction problem with management Surgery cut nerve:  function,  Pain

o Females  Can get pregnant nothing wrong with reproductive system

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Lack Sensation Can become Pregnant Problems with lubrication – KY Jelly

REHABILITATION – Begins on admission to hospital PSYCHOSOCIAL CONSIDERATIONS – Major life change; may be angry or bitter