injurty rotl

8/9/2019 injurty rotl

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2/46

SCI Statisti"s

# Mortality rate $ 1%&0's ( )0*

$ +oday ( ,*

# A-erage li.espan .ollo/ing SCI $ 0&0 years

# Highest in"iden"e $ 12000 ne/ "ases per year in 3S

$ 2240)0 $ 00%) li-ing /ith SCI in 3S

$ Males 1,0 years old

$ In"reasing in young .e5ales

$ !0* o. SCIs in-ol-e "er-i"al spine

021!1! 2


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4/46

Me"hanis5 o. Injury

# Hyper.le:ion $ Sudden de"eleration

$ Cspine "o55on

#Hypere:tension $ Most "o55on type $ ;hiplash

# A:ial loading

$ a


5/46

>re-ention o. SCI

# Sa.e dri-ing

# 3se o. seat ?elts @ "ar seats

# ;ear hel5ets

# Sui"ide @ -iolen"e pre-ention

# >re-ent .alls

# Athleti" prote"tion

# >roper se"urity o. .irear5s

021!1! !


6/46

Anato5y @ >hysiology o. Spinal Cord

# 3pper 5otor

neurons

$ Dri-e -oluntary

5o-e5ent

$ Des"ending 5otor

path/ay

$ ;ithin CNS

$ ead .ro5 ?rain to?rain ste5 or

anterior horn "ell o.

spinal "ord

021!1! ,


7/46

3pper Motor Neuron esion

# Injury a?o-e the le-el o. the anterior horn"ell

$ Anterior 6-entral7 horn proje"ts to s


8/46

Anato5y @ >hysiology o. Spinal Cord

# o/er 5otor neurons

$ Be"o5e part o.

peripheral ner-e to

5us"le

$ Condu"t i5pulsesoriginating in upper

5otor neurons

$ =esponsi?le .or

inner-ations and

"ontra"tion o. s


9/46

o/er Motor Neuron esion

# Injury at or ?elo/ the anterior horn "ell

$ Fla""id type paralysis

021!1! %


10/46

Sy5pto5 Co5parison o. esions

# 3pper 5otorneuron

$ Da5age to

des"ending

inhi?itory

ner-es that


11/46

Injury and Fun"tion

# Neurologi" le-el

$ o/est le-el at /hi"h sensory @ 5otor

.un"tion is nor5al

# Co5plete $ Co5plete disruption o. neural tissue

$ +otal loss o. sensory @ 5otor .un"tion ?elo/

le-el o. injury

$ Autono5i" dys.un"tion ?elo/ le-el o. injury

$ Irre-ersi?le

021!1! 11


12/46

Injury and Fun"tion

# Con"ussion

$ +ransient lo"alied neurologi" de.i"it

$ Full re"o-ery

# In"o5plete

$ aria?le degrees o. 5otor @or sensory

loss ?elo/ le-el o. injury

$ Certain tra"ts spared

$ >atterns 5ani.ested in syndro5es

021!1! 12


13/46

Spinal Cord +ra"ts

# Anterior horn

$ Motor

# >osterior horn

$ Sensory# ateral spinothala5i"

$ >ain @ +e5perature

# Dorsal "olu5ns

$ >osition o. ar5s @ legs

# Corti"ospinal tra"ts

$ Signals to 5o-e 5us"le

021!1! 1


14/46

Central Cord Syndro5e

# Central "ord injury

$ Cer-i"al area pri5arily

# 3pper e:tre5ity 5otor loss

# Spasti"ity o. lo/er e:tre5ities

# Sensory loss is -aria?le

# Bo/el?ladder dys.un"tion -aria?le

021!1! 1&


15/46

Anterior Cord

Syndro5e

# Belo/ le-el o. injury loss o. $ Motor .un"tion

$ +e5perature

$ >ain sensation# =e5ains inta"t

$ >roprio"eption

$ Motion sense

$ +ou"h $ i?ration

021!1! 1!


16/46

>osterior Cord Syndro5e ~

Rare

# Belo/ le-el o.

injury loss o.

$ >roprio"eption

$ i?ration

# =e5ains inta"t

$ Motor .un"tion o.

e:tre5ities

$ +ou"h $ >ressure

$ +e5perature

$ >ain

021!1! 1,


17/46

Bro/n Seuard Syndro5e

# Due to he5ise"tion o.

the "ord

$ Northsouth transe"tion

$ Eni.e or 5issile injury $ Fra"turedislo"ation

$ A"ute ruptured dis"

# Ipsilateral loss o.

$ oluntary 5otor

.un"tion

$ Sense o. tou"h $ i?ration

$ >roprio"eption

# Contralateral loss o.

$ >ain sensation

$ +e5perature

021!1! 14


18/46

>ri5ary Injury

# Injury that o""urs at i5pa"t

# Asso"iated /ith da5age to -erte?ral

"olu5n

# More 5o?ile areas 5ore .reuently

in-ol-ed

$ Cer-i"al area

021!1! 1)


19/46

Se"ondary Injury

# Injury that "ontinues hours a.ter trau5a# as"ular pathology

$ In"reased ?lood -essel per5ea?ility

# de5a# De"reased ?lood .lo/ to area

$ Further is"he5ia leads to ne"rosis# as"ular stasis# +hro5?osis

# Further de"rease in ?lood .lo/# +rau5ati" he5orrhagi" ne"rosis o. gray 5atter

021!1! 1%


20/46

Se"ondary Injury

# Neuronal pathology $ Altered ele"trophysiology o. neurons

# Sodiu5 lea


21/46

5ergen"y Manage5ent o. SCI

# IMMOBILIZEIMMOBILIZE

# Ne"< in neutral position

# +ransport to trau5a "enter or regional

spinal injury "enter

021!1! 21


22/46

5ergen"y Manage5ent o. SCI

# Monitor .or

progression o.

neurologi"al

de.i"its

# Highdose"orti"osteroids

$ Contro-ersial

studies

# 9:ygenation

# sta?lish ?aseline

assess5ent

# Sta?iliation o.

-erte?ral "olu5n

$ Cer-i"al

# S


23/46

Cer-i"al +ongs /ith Halo est

# Nursing "are $ >atient "o5.ort

# Balan"e

# oose "lothing

# +u? or sponge ?ath

# Support head /ith s5allpillo/ /hile sleeping

$ >in site "are

# Assess .or redness ordrainage

# Cleanse per proto"ol# +opi"al anti?ioti"s

$ S


24/46

Nursing Manage5ent o. SCI

# =espiratory $ Su"tion /ith "are to a-oid -agal ner-e irritation

$ Chest physiotherapy .or /ea< "ough

$ =outine ?reathing e:er"ises

$ Hydration and hu5idi.ied o:ygen $ For"ed e:piratory "ough

# Cardio-as"ular $ Da5aged sy5patheti"

.un"tion# Flu"tuation in B># Dysrhyth5ias

021!1! 2&


25/46


# GI $ Che"< tu?e .eeding residuals @ toleran"e o..eedings a.ter ?o/el sounds return

$ H2 antagonists or anta"ids

$ High "alorie high protein high .i?er

$ Bo/el retraining

$ Stool so.teners

$ Manual re5o-al o. stool on a routine 6i.needed /ith MN injury7

# G3 $ Inter5ittent "atheteriation

$ Assure adeuate .luids

$ +ea"h trigger -oiding te"hniue021!1! 2!


26/46


# S=9M

021!1! 2,


27/46


# >sy"hoso"ial $ 9pen "o55uni"ation

$ n"ourage de"ision 5a


28/46

Co5pli"ations

021!1! 2)


29/46

Spinal Sho"<

# >athophysiology

$ oss o. autono5i" ner-ous syste5 .un"tion

?elo/ le-el o. injury

$ Sudden depression o. re.le:es ?elo/ le-el o.injury

$ Are.le:ia

$ Fla""id paralysis

$ a"< o. ?ladder and ?o/el .un"tion

021!1! 2%


30/46

Spinal Sho"<

# Nursing Assess5ents

$ Hypotension

$ Brady"ardia

$ Hypother5ia $ Bo/el distention

$ >aralyti" ileus

$ a"< o. perspiration on paralyed parts

$ =espiratory depression.ailure

021!1! 0


31/46

Spinal Sho"<

# NursingMedi"al Manage5ent

$ Sta?iliation o. SCI

$ Support o. -ital organ .un"tion

# >las5a e:pander 6de:tran7# Systoli" B> %0100

# Heart rate ,0100 ?p5

# 3rine output 5ore than 05h

# >re-ent hypother5ia# Intestinal de"o5pression /ith nasogastri" tu?e

021!1! 1


32/46

+hro5?ophle?itis

# >athophysiology

$ Stasis

$ I55o?ility

$ De"reaseda?sent

5us"le "ontra"tion

021!1! 2


33/46

+hro5?ophle?itis 5?olis5

# Nursing Assess5ents $ D+

# eg s/elling

# =edness

# In"reased te5perature o. a..e"ted e:tre5ity


$ >ul5onary e5?olis5

# >leuriti" "hest pain

# An:iety

# Shortness o. ?reath

# Arterial ?lood gases

021!1!


34/46

+hro5?ophle?itis 5?olis5


$ o/ dose anti"oagulants

# Su? heparin

# o-eno:

$ :ternal "o5pression de-i"e

# >neu5ati" seuential "o5pression de-i"e

# +D hose

$ Ind/elling -ena "a-a .ilter

# >re-ent pul5onary e5?olis5

021!1! &


35/46

9rthostati" Hypotension

# >athophysiology

$ Interruption in re.le: ar"s that produ"e

-aso"onstri"tion

$ asodilation $ >ooling in a?do5en @ lo/er e:tre5ities

$ Co55on in lesions a?o-e +4

021!1! !


36/46



$ 2055 Hg de"rease in SB>

$ 1055 Hg de"rease in DB>

$ ;ea


37/46


# NursingMedi"al Manage5ent $ asopressors

$ +D hose

$ A?do5inal ?inders

$ Gradual position "hanges

$ +ilt ta?les

021!1! 4


38/46

Autono5i" Dysre.le:ia

# >athophysiology $ A"ute e5ergen"y

# Can pre"ipitate a seiure or stro


39/46



$ Se-ere pounding heada"he

$ Nasal "ongestion

$ >aro:ys5al hypertension $ Brady"ardia

$ >ro.use diaphoresis a?o-e le-el o. injury

$ >ale "old dry s


40/46


# +riggers $ Distended ?ladder

$ Distention or "ontra"tion o. -is"eral organs

# >ri5arily ?o/el "onstipation or i5pa"tion $ Sti5ulation o. s


41/46



$ =e5o-e trigger

$ +reatpre-ent "o5pli"ations

# Sitting position to de"rease B># =e5o-e "o5pression sto"


42/46

>riority >ro?le5s

# Cer-i"al SCI

$ I55o?iliation o.

"er-i"al spine

$ Cer-i"al "ollar

$ 3se o. ?a"


43/46

>riority >ro?le5s

# u5?ar SCI

$ Mo?ility

# Sa"ral SCI

$ Bo/el

$ Bladder $ Se:ual .un"tioning

021!1! &


44/46

Se:ual =eha?ilitation /ith SCI

# Males $ =e.le: ere"tions 5ay o""ur

# >sy"hogeni" $ =esults .ro5 se:ual thoughts

# =e.le:ogeni" $ =esults .ro5 sti5ulation o. penis

J Changing "atheter J >ulling pu?i" hair

$ 3se.ulness .or se:ual a"ti-ity is -aria?le

# Spontaneous $ =esults .ro5 so5e type o. internal sti5ulation

J Full ?ladder $

Ho/ long ere"tion lasts /ill deter5ine use.ulness .or se:uala"ti-ity

$ 3sually la"< eja"ulation# ja"ulation 5ay "ause autono5i" dysre.le:ia

$ =e.er to urologist .or ne/ ere"tile and .ertilitytreat5ents

021!1! &&


45/46

Se:ual =eha?ilitation /ith SCI

# Fe5ales

$ =e5ain "apa?le o. se:ual inter"ourse

# a"< a?ility to a"hie-e orgas5

$ =e5ain "apa?le o. "on"eption $ Menses generally resu5es , 5onths

post injury

$ Monitor pregnan"y "losely due to ris<

.or pre5ature deli-ery and s5all?irth/eight in.ants

021!1! &!


46/46

injurty rotl

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