Spinal Cord Injuries (SCIs) - BMS

Spinal Cord Injuries (SCIs)

• SCIs can be complete or incomplete
• Types of injuries: primary (related to the initial injury) and secondary (worsens the injury)
• Secondary injuries can be hemorrhage, ischemia, impaired tissue perfusion from shock, hypovolemia, or local edema

Risk Factors

• Young males
• Trauma (e.g., motor vehicle crashes, falls, acts of violence)
• Sports and recreational activities (e.g., diving in shallow water)
• Importance of prevention: educate patients to avoid risk-taking behaviors, wear protective gear/equipment, wear seatbelts, and avoid impaired driving

Level of Injury

• Level of injury depends on where the injury occurred
• Terms: -plegia (complete loss of motor function) vs -paresis (partial loss)
• Tetra- (quadri-) refers to all four limbs
• Para- refers to partial or incomplete paralysis
• C3-C5 injuries can result in respiratory compromise

Signs & Symptoms

• Cardiovascular: bradycardia, hypotension, hypothermia, potential for cardiac dysrhythmias
• Respiratory: difficulty breathing, difficulty clearing secretions
• Neuromuscular: loss of movement, numbness, tingling, or loss/change to sensation in extremities, immobility, unsteady gait
• Gastrointestinal: loss of bowel control
• Genitourinary: loss of bladder control
• Psychosocial: changes in sexual function

Diagnosis

• CT or MRI of the spine
• X-ray of spine
• CMP (or BMP) and CBC for baseline

Initial Care of SCIs

• ABCs are the priority
• Spinal precautions: log roll patients, keep cervical collar on until cleared by healthcare provider
• C3-5 injuries require respiratory assessment and cervical collar
• Evaluate: HR, BP, and peripheral perfusion (pulse strength and capillary refill)
• Assess for hemorrhage (hypovolemia)
• Frequent Glasgow Coma Scale (GCS) to assess cognitive impairment
• Assess patient’s sensory perception
• Spinal Shock Syndrome

Treatments

• Medications:
  • Atropine sulfate (Isopto Atropine) for symptomatic bradycardia
  • IV medications to raise BP (e.g., midodrine (ProAmatine))
  • Proton pump inhibitors (e.g., pantoprazole, omeprazole, lansoprazole) to prevent stress ulcers
  • Muscle relaxers (e.g., baclofen (Lioresal) or methocarbamol (Robaxin)) to prevent muscle spasticity or pain
• Surgical: spine stabilization, post-operative care depends on level of injury and specific surgery completed
• Non-Surgical: immobilization of the spine with a specific orthosis (brace), examples include cervical collar, halo crown, thoracic-lumbar sacral orthosis (TLSOs)

SCI Complications

• Respiratory
• Autonomic Dysreflexia (potentially life-threatening hypertensive emergency)
• Mobility
• Cardiovascular
• Integumentary
• Genitourinary
• Gastrointestinal
• Venous thromboembolisms

Autonomic Dysreflexia

• Causes: gynecological-urological, gastrointestinal, or vascular stimulation
• Examples: urinary tract infection, full bladder, fecal impaction, bowel distention, irritation of hemorrhoids, pain, circumferential constriction of the body
• Treatment:
  • Sit patient upright
  • Remove the stimulus (e.g., straight catheterize patient with full bladder)
  • Treat the patient’s blood pressure

Spinal Cord Injuries (SCIs)

• SCIs can be complete or incomplete
• Types of injuries: primary (related to the initial injury) and secondary (worsens the injury)
• Secondary injuries can be hemorrhage, ischemia, impaired tissue perfusion from shock, hypovolemia, or local edema

Risk Factors

• Young males
• Trauma (e.g., motor vehicle crashes, falls, acts of violence)
• Sports and recreational activities (e.g., diving in shallow water)
• Importance of prevention: educate patients to avoid risk-taking behaviors, wear protective gear/equipment, wear seatbelts, and avoid impaired driving

Level of Injury

• Level of injury depends on where the injury occurred
• Terms: -plegia (complete loss of motor function) vs -paresis (partial loss)
• Tetra- (quadri-) refers to all four limbs
• Para- refers to partial or incomplete paralysis
• C3-C5 injuries can result in respiratory compromise

Signs & Symptoms

• Cardiovascular: bradycardia, hypotension, hypothermia, potential for cardiac dysrhythmias
• Respiratory: difficulty breathing, difficulty clearing secretions
• Neuromuscular: loss of movement, numbness, tingling, or loss/change to sensation in extremities, immobility, unsteady gait
• Gastrointestinal: loss of bowel control
• Genitourinary: loss of bladder control
• Psychosocial: changes in sexual function

Diagnosis

• CT or MRI of the spine
• X-ray of spine
• CMP (or BMP) and CBC for baseline

Initial Care of SCIs

• ABCs are the priority
• Spinal precautions: log roll patients, keep cervical collar on until cleared by healthcare provider
• C3-5 injuries require respiratory assessment and cervical collar
• Evaluate: HR, BP, and peripheral perfusion (pulse strength and capillary refill)
• Assess for hemorrhage (hypovolemia)
• Frequent Glasgow Coma Scale (GCS) to assess cognitive impairment
• Assess patient’s sensory perception
• Spinal Shock Syndrome

Treatments

• Medications:
  • Atropine sulfate (Isopto Atropine) for symptomatic bradycardia
  • IV medications to raise BP (e.g., midodrine (ProAmatine))
  • Proton pump inhibitors (e.g., pantoprazole, omeprazole, lansoprazole) to prevent stress ulcers
  • Muscle relaxers (e.g., baclofen (Lioresal) or methocarbamol (Robaxin)) to prevent muscle spasticity or pain
• Surgical: spine stabilization, post-operative care depends on level of injury and specific surgery completed
• Non-Surgical: immobilization of the spine with a specific orthosis (brace), examples include cervical collar, halo crown, thoracic-lumbar sacral orthosis (TLSOs)

SCI Complications

• Respiratory
• Autonomic Dysreflexia (potentially life-threatening hypertensive emergency)
• Mobility
• Cardiovascular
• Integumentary
• Genitourinary
• Gastrointestinal
• Venous thromboembolisms

Autonomic Dysreflexia

• Causes: gynecological-urological, gastrointestinal, or vascular stimulation
• Examples: urinary tract infection, full bladder, fecal impaction, bowel distention, irritation of hemorrhoids, pain, circumferential constriction of the body
• Treatment:
  • Sit patient upright
  • Remove the stimulus (e.g., straight catheterize patient with full bladder)
  • Treat the patient’s blood pressure