Spinal Cord Injuries

Created by conleyl 

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Spinal Shock: What, When, How long?

*Temporary physiological state that can occur after a spinal cord injury in which all sensory, motor, and sympathetic functions of the nervous system are lost below the level of injury, damaged & undamaged nerves unable to send msg to brain; Spinal shock can lower blood pressure to dangerous levels and cause temporary paralysis
*Occurs immediatly following injury
*Manifestations are evident witihn 30-60 min: may have complete paralyses, loss of reflex and sensation in limbs
*Duration is usually 1-6 weeks
*The farther down the injury, the better the prognosis
*Return of relex activity indicates resolution of spinal cord*
**Intervention: HOB flat, even if there is increased ICP**

Cervical Level of Injury (LOI) C1-C8

C1-C3 = Complete loss of phrenic nerve innervation affecting diaphragm/breathing b/c phrenic nerve innervates at C3-C5
*Interventions: Must intubate w/ long-term mechanical ventilation
*Quadraplegic-will need help with almost all mobility, self-care, bladder and bowel care
C4 = Will have innervation of phrenic nerve,
*Quadaplegic- receive mechanical ventilation initially, won't need long-term mechanical ventilation

Cervical Level of Injury (LOI) C5-C8

C5 = Functional use of elbow flexion, can assist with upper extremity dressing and bed mobility
Intervention: prevent contractures of elbow flexion
C6 = Functional wrist extension permitting passive thumb adduction on the index finger (tenodesis)
*Highest level at which patient can have complete injury and still maintain independent functioning
C7 = Tricep function allows elbow extention
C8 = Functional finger flexion, which improves their independence in terms of hand grasp and release.

Thoracic Level of Injury (LOI) T1-T12

T1-T12 paraplegia = innervation and function of all upper extremity muscles, including those for hand function
T1-T6 = control signals to the back of the head, the neck and shoulders
T7-T12 = controls signals to upper part of the abdomen
**T8-T12: Impaired cough

Lumbar Level of Injury (LOI) L1-L5

Leg muscles
Control signals to the lower parts of the abdomen and the back, the buttocks, some parts of the external genital organs, and parts of the leg
*Paraplegia - can achieve functional independence for all mobility, self-care, and bladder and bowel skills

Sacral Level of Injury (LOI) S1-S5

Bowel, bladder, sexual function
Control signals to the thighs and lower parts of the legs, the feet, most of the external genital organs, and the area around the anus

Autonomic Dysreflexia

Excessive, uncontrolled sympathetic output characterized by severe HPT, bradycardia, severe h/a, nasal stuffiness, skin flushing (above LOI), pale extremities (below LOI), sweating, nausea, blurred vision, piloerection, feeling of apprehension
*Can occur after spinal shock (remember spinal shock turns off sympathetic nervous system)
*Occurs in patients with T6 and higher injuries

Autonomic Dysreflexial Interventions

*Place patient in sitting position (first priority!)
*Page/notify helath care provider
*Loosen tight clothing on the patient
*Assess for and treat the cause
*Check the urinary cath tubing (if present) for kinks for obstruction
*If cath not present, check for bladder distention and cath immediately if indicated
*Place anesthetic ointment on tip of cath before insertion
*Check room temp to ensure that it is not too cool or drafty
*Monitor B/P q10-15 min
*Give nitrates or hydralazine (Apresoline) per Rx

Brown Sequard Syndrome

Results from penetrating injuries that cause hemisection of the spinal cord or injuries that affect half of the spinal cord
*Motor function, proprioception (position sense), vibration, & deep touch sensations are lost ipsolaterally
*Pain, temperature, and light touch are loss contralaterally

Sexual Functioning LOI C1-C3

Females- reflex lubrication possible, libido intact
Males- reflex erection possible, libido intact

Sexual Functioning LOI C4-C6

Females- nongenital orgasm possible
Males- nongenital orgasm possible, no ejaculation

Sexual Functioning LOI T12-L5

Females- experience of orgasm possible but difficult
*Fertility is not impaired
Males- non-reflex errection is possble, but not ejaculation
*Fertility is usually impacted

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