Week 4 Spinal Cord PDF

Injuries can be classified as - irreversible damage to Spinal Cord Injuries neurons - Primary(initial) neurologic injury - Injury to neural elements (neurons...

Injuries can be classified as - irreversible damage to Spinal Cord Injuries neurons - Primary(initial) neurologic injury - Injury to neural elements (neurons&axons) of the spinal cord - Secondary injury - 80% of injuries are males and 80% are under 30 yrs old - Injury after the injury often due to inflammatory process & - Risky behavior&drugs/alchols are factor any process that leads to ischemia Caused Spinal Shock vs. Neurogenic Shock - Direct injury to spinal cord - Penetrating trauma - not common Spinal Shock - has to do with the injury itself - Indirect injury caused by flexion, extension, or rotaional injuries - Vertebral fracture, subluxation or dislocation happens right after the trauma - Due to acute spinal cord injury Manifestions after SCI - Sudden loss of all voluntary & reflex activity below level of injury - Ex. usually see with transected spinal cord - Contused - bruised (can lead to infarctions) - Compressed - infarcted (No blood flow to that portion of the cord ie. MI) Manifestions - transient (days to weeks) - Laceration (transected) ie. cut - Lose DTR (deep tendon reflexes) - can be back before hospital like - Common area to be injured anywhere from C4 to C6 concussion - higher injuries will see tetrapelegia - Lack sensations - paralyzed legs and arms - Flacid paralysis (almost floppy) - cannot do anything - lower injuries will see parapelegia - Can get loss of bowel function - Paralyzed legs and lower body Neurogenic Shock (circulatory shock) Pathology - Loss of ANS function - Immediate damage to spinal cord causes… - Occurs only with SCI above T6 - Spinal cord shock - temporary complete loss of functions below injury Primary injury - irreversible What nerves innervate the diaphragm? - Phrenic nerve (typically C3-C5) - Occurs at time of mechanical injuries due to forces such as - C4 still can breathe but not have a good cough compression, streching or shearing - Anything below C5 deep breathing and coughing less impaired What symptoms might accompany an injury at C7/T1 Patho - Conscious and breathing - Small hemorrhages in grey matter of SC - Unable to move arms or legs - Edema of white matter in SC - Eventually leads to necrosis of neural tissue SCi Classification: Complete Vs. Incomplete Complete: loss of all motor & sensory function Secondary injury - reversible below level of injury - inflammation, excitotoxicity, ischemia, hemorrhage, hypoxia - No movement - Occurs when neurons&white matter in area of initial damaged are - No sharp/dull sensation affected and allow primary injury to spread (worsen); possible - No hot/cold sensation causes include… - No vibration sensation - No sensation of light/deep touch Patho - No sense of position of arms/legs - Damage to blood vessels supplying the area - do CT scan and treat it - No bowel/bladder control - Low vasomotor tone (vasodilation) which can vasoconstriction & low blood supply - body normal reaction can cause further damage Incomplete: some sensory or motor function - Local release of substance (E &NE) that cause vaspasm - can lead to ischemia below level of injury maintained but may have… - Release of digestive enzymes from damaged cells - big factor; can cause swelling and demylinization and eventual necrosis Anterior cord syndrome: Damage to anterior section of cord SCI injury Levels - Motor function affected; touch, sensation not affected Manifestations correlate to level of injury & all levels below injury What key functions can be affected by SCI? Central cord syndrome: damage to axons near grey - Breathing → C3 & above loss of diaphragm function (require matter mechanical ventilator for the rest of life) - Arms more affected than legs - Effects cortitcalspinal tracts (motor) Brown-Sequard syndrome: damage to one side of Autonomic Dysreflexia - Acute emergency cord - Occurs after spinal shock has resolved & may occur years after the - Motor function lost on that side (same side) injury - pain/temp senations lost from other side - b/c cannot go to brain - Occurs in persons with an SC lesion above T6 where control of spinal reflexes are lost Diagnostic Tests - Autonomic nervous system responses are exaggerated in response to triggering stimuli - Spine X-rays - Exaggerated SNS response to triggers manifestations due to excess - Look for fractures (ie. compression or moving certain way) SNS - CT scan - MRI What can trigger it? - Sometimes to check below flow for any secondary damages - Physical exam A visceral stimulus (e.g., full bladder, constipation, ingrown toenail) triggers - SC testing routine an exaggerated sympathetic nervous system (SNS) response in individuals - Very specific steps for testing (ie. neurological tests etc) with spinal cord injury. The bladder becomes distended, sending sensory signals that can’t reach the brain due to the injury. Instead, it activates local sympathetic reflexes below the injury, causing release of epinephrine (E) Concerns & Complication after SCI and norepinephrine (NE), which leads to vasoconstriction, cool, pale skin, - Hypotension, bradycardia and a sudden rise in blood pressure (BP). - DVT - high risk b/c immobile & a lot of vasomotor issue - Pulmonary embolism “” The high BP triggers baroreceptors, which activate the parasympathetic - Peripheral edema “” nervous system (PNS), slowing the heart rate (bradycardia, ~40 bpm). - Infections (UTIs, pneumonia, wounds, sepsis) However, the PNS can’t counter the SNS effects below the injury, resulting in - Skin break down - pressure ulcers vasoconstriction below the injury and vasodilation above it. This - Bowel, bladder, sexual dysfunction imbalance, along with goosebumps (piloerection) below the injury, - Poikilothermy characterizes the condition. - Automonomic dysreflexia - acute emergency after spinal shock What signs and symptoms should the nurse be aware of? - Can happen even yrs later - With spinal cord lesions above T6 (has to do with autonomic - Massive headache due to high blood pressure nervous system - Flushed face from vasodilation above the injury - Cool, clammy extremities due to vasoconstriction below the injury - Nasal stuffiness from vasodilation in nasal passages. - Be cautious with C4/C5 spinal injuries—patients may not be able to express that they have a headache due to difficulty speaking. Therapeutics for SCI - Immobilize & realign spine (brace,halo,surgery) - Prevent hypotension & hypoxia - Methylprednisolone - bowel/bladder, skincare - some don’t use - Rehabilitation - important preventative care - Supportive care - Stem cells transplants (someday) BIG GOAL: to reduce neurological deficits & to prevent any further loss of neurological function.