SCI Lecture: Spinal Shock, Complications & Autonomic Dysreflexia - PDF

SCI Part 2 Mayank Jain  Spinal Shock Immediately following SCI ➔ Areflexia called spinal shock. Characteristics Autonomic regulation will be impaired ➔hypotension , loss of control of sweating and piloerection. Loss of all Reflexes ➔DTR , bulbocavernosus reflex,...

SCI Part 2 Mayank Jain  Spinal Shock Immediately following SCI ➔ Areflexia called spinal shock. Characteristics Autonomic regulation will be impaired ➔hypotension , loss of control of sweating and piloerection. Loss of all Reflexes ➔DTR , bulbocavernosus reflex, the cremasteric reflex, a Babinski response. Recovery from Spinal Shock The initial period of areflexia last approximately 24 hours. Gradual return of reflexes ➔1 to 3 days Period of increasing hyperreflexia ➔1 to 4 weeks Final hyperreflexia ➔1 to 6 months after injury Which reflex will come back first ?  Complications of SCI What is a Complication ? Primary Complications Secondary complication Spinal Shock Pressure Sores Autonomic Dysreflexia Pneumonia Spastic Hypertonia DVT CV Complications Pain Pulmonary complications Bladders and Bowel Dysfunctions Heterotrophic Ossification Fractures  Sympathetic System V/S Parasympathetic Sympathetic Activity (S-S) Stress Parasympathetic System (P-P) Peace Control Area Sympathetic Ganglion Chain along Sacral Segment S2, S3, S4 the spine T1- L2 CN Nerve- CN III, VII, IX, X ( Brain Stem) During Rest Normally not working during rest Normally Prevail during rest Function when “Fight or Flight” response to stress. “Rest and Digest” system; stimulated Increases heart rate, Reduces heart rate, Dilates or opens the lungs, Increases salivation, Inhibits digestion and dilates the pupils, Increases urine secretion from the kidneys Vasoconstriction Constricts the pupils. Promotes digestion, On a day-to-day basis, these two pathways work in parallel to maintain homeostatic balance within the body  Autonomic Dysreflexia C/F- Increase Sweating, Flushing , Head Ache , Blurred Vision Hypertension triggered by AD can lead to ➔ seizures, cardiac arrest, subarachnoid hemorrhage, stroke, or even death. Common in the chronic stage of recovery (more than 3 to 6 months after injury), but may also occur in the early stages after SCI. It is more common with complete injury, but it may also occur with an incomplete SCI also. A rise in systolic blood pressure of 20 to 30 mm Hg is diagnostic of an episode of AD Intervention Change the position to upright in order to reduce BP Loose tight clothing Look for trigger point ➔ check any bladder distension , Bowel impaction , ask pt about last bowel movement , pressure sores etc *Which is first , changing position or looking for trigger point ? *Continuously monitor pulse and blood pressure – how often ?  Decreased Forced Expiratory volume In sitting ➔the lack of abdominal muscle (T5-T12) innervation causes abdominal contents to fall forward and pull down on the central tendon of Diaphragm. This changes the motion of the ➔diaphragm when it contracts during inspiration resulting in an inefficient breathing pattern. Also The lack of full abdominal muscle function also impairs the ability to cough and clear the airway. FEV is volume of air expired after normal expiration , which need abdominal and other intercostal muscle.