Questions and Answers
What are the two types of spinal cord injuries?
Secondary injuries can worsen the initial injury.
True
Which of the following is a risk factor for spinal cord injuries?
What level of injury can cause respiratory compromise?
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The loss of bladder control is a sign and symptom of __________.
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Match the following primary symptoms with their categories:
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What is a common diagnostic method for spinal cord injuries?
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Spinal precautions are not necessary in the initial care of spinal cord injuries.
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What is a complication of autonomic dysreflexia?
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What should be done if a patient experiences autonomic dysreflexia?
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What are the two main types of spinal cord injuries?
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Young males are at a higher risk for spinal cord injuries.
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What is the significance of a cervical collar in patients with suspected spinal cord injuries?
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The initial care priority for spinal cord injuries is the _____ airway, breathing, and circulation.
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What medication is given to treat symptomatic bradycardia?
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Unsteady gait is a potential sign of spinal cord injury.
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The Glasgow Coma Scale (GCS) is used for assessing _____ impairment.
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What is autonomic dysreflexia?
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Which of the following is NOT a symptom of autonomic dysreflexia?
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What should be done to treat a patient experiencing autonomic dysreflexia?
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Study Notes
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
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Description
Learn about the types and risk factors of Spinal Cord Injuries (SCIs), including primary and secondary injuries, and how to prevent them.
