Spinal Cord Injury
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1
SCI
Symptoms depend on ___________ and ___________ of injury.
Symptoms depend on ___________ and ___________ of injury.
Location and severity
2
SCI
What is the difference between incomplete and complete SCI?
What is the difference between incomplete and complete SCI?
- Incomplete: Varying degree of function below injury
- Complete: No motor or sensation below injury + Loss of vascular tone below the level of injury + Loss of reflexes initially (hyperreflexia later)
- Complete: No motor or sensation below injury + Loss of vascular tone below the level of injury + Loss of reflexes initially (hyperreflexia later)
3
SCI
What is tetraplegia?
What is tetraplegia?
Paralysis caused by SCI that results in the partial or total loss of use of all four limbs and torso
- Injury occurring between C4-C6
- Injury occurring between C4-C6
4
SCI
What is paraplegia?
What is paraplegia?
Paralysis of the legs and lower body due to SCI
- Injury occurring T1 and below
- Injury occurring T1 and below
5
SCI - Hemodynamic Problems
Disruption in what part of the CNS that can potentially lead to neurogenic shock?
Disruption in what part of the CNS that can potentially lead to neurogenic shock?
Autonomic nervous system
6
SCI - Hemodynamic Problems
Hypotension occurs in injuries above _____.
Bradycardia occurs in injuries above _____.
Hypotension occurs in injuries above _____.
Bradycardia occurs in injuries above _____.
- Hypotension = Above T4
- Bradycardia = Above T1
- Bradycardia = Above T1
7
SCI - Hemodynamic Management
Initially during the acute period of injury, what are the MAP goals?
What is often used to achieve these goals?
Initially during the acute period of injury, what are the MAP goals?
What is often used to achieve these goals?
- Higher MAP goals of 80-85 mmHg considered in the first 7 days to improve perfusion
- NE recommended to use
- NE recommended to use
8
SCI - Hemodynamic Management
After the acute period of injury, what are the MAP goals?
After the acute period of injury, what are the MAP goals?
> 65 mmHg
9
SCI - Hemodynamic Management
After the acute period of injury, what agent can be used if the patient is hypotensive without bradycardia?
After the acute period of injury, what agent can be used if the patient is hypotensive without bradycardia?
Midodrine 5-10 mg PO Q8 hrs
10
SCI - Hemodynamic Management
After the acute period of injury, what agent can be used if the patient has symptomatic bradycardia with hypotension?
After the acute period of injury, what agent can be used if the patient has symptomatic bradycardia with hypotension?
Pseudoephedrine 30 mg PO q6 hrs
11
SCI - Respiratory Management
Why are SCI patients prone to pneumonias?
Which injury locations typically are ventilator dependent?
Why are SCI patients prone to pneumonias?
Which injury locations typically are ventilator dependent?
- Loss of mucociliary function -> Difficulty clearing secretions = Prone to pneumonias
- C4-C5 injuries: Usually ventilator dependent
- Injuries above T1: May require ventilator for a period of time due to loss of intercostal muscle function
- C4-C5 injuries: Usually ventilator dependent
- Injuries above T1: May require ventilator for a period of time due to loss of intercostal muscle function
12
SCI - DVT Ppx
When should it be started?
How long should it be used for?
When should it be started?
How long should it be used for?
- Early administration of DVT prophylaxis (within 72 hours) is recommended
- 3 month duration is recommended
- 3 month duration is recommended
13
SCI - DVT Ppx
In addition to LMWH, what else is recommended for SCI patients?
In addition to LMWH, what else is recommended for SCI patients?
Mechanical prophylaxis
14
SCI Tx
T/F: Stress ulcer is not indicated for these patients.
T/F: Stress ulcer is not indicated for these patients.
FALSE -- It is indicated
15
SCI Tx
Duration of stress ulcer ppx?
Duration of stress ulcer ppx?
H2 blocker or PPI for 4 weeks
16
SCI Tx
T/F: Administration of methylprednisolone for acute spinal cord injury is NOT recommended.
T/F: Administration of methylprednisolone for acute spinal cord injury is NOT recommended.
TRUE! - No steroids are
17
SCI - Constipation
What should be started with nutrition with the goal of a bowel movement within 48 hrs?
What should be started with nutrition with the goal of a bowel movement within 48 hrs?
- 1st line = Stimulant (senna or milk of magnesia) + Stool softener (docusate)
- 2nd line = Suppository (Bisacodyl)
- 2nd line = Suppository (Bisacodyl)
18
SCI Long-Term Complications
For spinal spasticity, what are the two routes of admin used to aid in symptom relief?
For spinal spasticity, what are the two routes of admin used to aid in symptom relief?
Oral or intrathecal medications
- Intrathecal only if unresponsive to oral or intolerable side effects with oral
- Intrathecal only if unresponsive to oral or intolerable side effects with oral
19
SCI Long-Term Complications
First-line treatment for spinal spasticity?
First-line treatment for spinal spasticity?
Central-acting oral antispasmodics
- Diazepam, clonazepam (especially at night)
- Baclofen (effective for spasms in flexor muscles)
- Tizanidine (monitor for hypotension)
- Gabapentin (may be helpful with neuropathic pain)
- Diazepam, clonazepam (especially at night)
- Baclofen (effective for spasms in flexor muscles)
- Tizanidine (monitor for hypotension)
- Gabapentin (may be helpful with neuropathic pain)
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