1SCI
Symptoms depend on ___________ and ___________ of injury.
Location and severity
2SCI
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)
3SCI
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
4SCI
What is paraplegia?
Paralysis of the legs and lower body due to SCI
- Injury occurring T1 and below
5SCI - Hemodynamic Problems
Disruption in what part of the CNS that can potentially lead to neurogenic shock?
Autonomic nervous system
6SCI - Hemodynamic Problems
Hypotension occurs in injuries above _____.
Bradycardia occurs in injuries above _____.
- Hypotension = Above T4
- Bradycardia = Above T1
7SCI - Hemodynamic Management
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
8SCI - Hemodynamic Management
After the acute period of injury, what are the MAP goals?
> 65 mmHg
9SCI - Hemodynamic Management
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
10SCI - Hemodynamic Management
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
11SCI - Respiratory Management
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
12SCI - DVT Ppx
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
13SCI - DVT Ppx
In addition to LMWH, what else is recommended for SCI patients?
Mechanical prophylaxis
14SCI Tx
T/F: Stress ulcer is not indicated for these patients.
FALSE -- It is indicated
15SCI Tx
Duration of stress ulcer ppx?
H2 blocker or PPI for 4 weeks
16SCI Tx
T/F: Administration of methylprednisolone for acute spinal cord injury is NOT recommended.
TRUE! - No steroids are
17SCI - Constipation
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)
18SCI Long-Term Complications
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
19SCI Long-Term Complications
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)