Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 37: Spinal Cord Injury.

Slides:



Advertisements
Similar presentations
Head and Spinal Trauma RIFLES LIFESAVERS.
Advertisements

Consultant Orthopedic & Spinal Surgeon
Thoracolumbar Fractures Patient Evaluation and Management.
Spinal Cord Injury.
An Upward Trend in Motorcycle Crashes By Joan M. Pirrung, RN, APRN-BC, and Pamela Woods, RN, CEN, BSN, SANE-A Nursing2009, February ANCC contact.
Spinal Cord Disorder Michael H. Wilhelm, CRNA, APRN.
Spinal Cord Compression By: Sharon Sanders, Stacy Webb, Tonya Miller, Adrianne Rice & Lynn Davenport.
Peripheral and Spinal Cord Problems Zoya Minasyan RN, MSN-Edu.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 25 Mechanical Immobilization.
Neurological Injury Management Neurological Injury Management.
Chapter 40 Pediatric Trauma Emergencies. © 2005 by Thomson Delmar Learning,a part of The Thomson Corporation. All Rights Reserved 2 Overview  Pediatric.
Dr Mostafa Hosseini M.D. “Head and Neck Surgeon”
MANAGEMENT OF NEUROLOGIC DISORDERS. What is Traumatic Brain Injury? Closed – head collides with another object but there is no opening through the skull.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 11: The Critically Ill Pregnant Woman.
Spinal Trauma. Anatomy and Physiology  Vertebral Column  Spinal Cord.
National Ski Patrol, Outdoor Emergency Care, 5th ©2012 by Pearson Education, Inc., Upper Saddle River, NJ BRADY Shock Chapter 10.
Trauma, Multiple Casualties. Polytrauma Multisystem trauma Terminology: 4 Injury = the result of harmful event that arieses from the release of specific.
Lesson 7B Disability — Part Two
A Case of Acute Spinal Trauma Scott Silvers, MD, FACEP.
SPINAL CORD INJURY Jessica Ryu, T4 Tulane University School of Medicine.
Unit 35 Spinal Injuries.
Spinal Cord Injuries.  There are an estimated 10,000 to 12,000 spinal cord injuries every year in the United States.  The cost of managing the care.
Neurosensory: Traumatic Spinal Cord Injury. A. Pathophysiology/etiology Normal spinal cord as it relates to SCI Spinal cord begins at the foramen magnum.
What is the spinal cord? The spinal cord is a bundle of nerve fibers and associated tissue that is enclosed in the spine. These fibers connect nearly.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 6 Advanced Respiratory Care Skills.
Chapter 22 Spine Injuries.
Spinal Cord Function After Injury spinal cord structure in relation to vertebrae types of lesions fibre tracts in spinal cord sensory loss motor loss reflexes.
Spine and Spinal Cord Trauma. Objectives Anatomy/physiology Evaluate a patient with spinal injury Identify common spinal injuries and Xray features Appropriately.
First Aid for Colleges and Universities 10 Edition Chapter 13 © 2012 Pearson Education, Inc. Head and Spine Injuries Slide Presentation prepared by Randall.
Waleed Awwad. MD, FRCSC Assistant professor Consultant spine and scoliosis Waleed Awwad. MD, FRCSC Assistant professor Consultant spine and scoliosis.
SPINAL CORD INJURY USAF CSTARS Baltimore University of Maryland Medical Center R A Cowley Shock Trauma Center.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Timby/Smith: Introductory Medical-Surgical Nursing, 10/e Chapter 62: Caring for.
Chapter 32 Shock Copyright (c) The McGraw-Hill Companies, Inc. Permission required for reproduction or display.
1 Trauma Injuries to the Head and Spine. 2 The Nervous System Review.
Spine Examination รศ.นพ. สุรชัย แซ่จึง ภาควิชาออร์โธปิดิกส์
Diagnosis of Spinal Cord Injuries. Traumatic Spinal Cord Injury Immediate loss of strength Immediate numbness in legs and arms Level of injury can predict.
Spinal Cord Injury By Dr. Hanan Said Ali. Objectives Define spinal cord injury. Identify the Aetiology of spinal cord injury. Describe the mechanisms.
Objectives  The ability to demonstrate knowledge of the following:  Basic anatomy of the spine.  Initial assessment and treatment of spinal injuries.
{ Spinal Cord Injury A complete or Incomplete break in the Spinal Cord.
Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 21 Oxygenation.
Guillain-Barre’ Syndrome
Spinal Cord Injury By: Christine Kerr 4th Period.
Head Neck and Spinal Injuries April Morgenroth EMT, RN, BSN.
By: Jean Collado. About The Spinal Cord  The spinal cord is about 18 inches long and extends from the base of the brain, down the middle of the back,
Module 5-3 Injuries to Muscles and Bones. Review of the Musculoskeletal System Injuries to Bones and Joints Injuries to the Spine Injuries to the Brain.
SPINAL INJURIES. 2 Spine  7 Cervical  12 Thoracic  5 Lumbar  5 Sacral  4 Coccyx.
Shock. Outlines Definitions Signs and symptoms of shock Classification General principles of management Specific types of shock.
Shock It is a sudden drop in BP leading to decrease
SPINAL CORD INJURY What is the spinal cord?
Cervical Radiculopathy. Normal Anatomy Cervical spinal nerves exit via the intervertebral foramen Intervertebral foramen is the gap between the facet.
Thoraco-lumbar fractures Common injuries. 50% caused by MVA; rest by falls and sporting injuries. Commonly associated injuries; injuries at another level(10%-15%),
Cervical Fractures Stenberg College Nursing students 2014.
Chapter 45 Care of Patients with Problems of the Central Nervous System: The Spinal Cord A cross section of the spinal cord.
 Fractures  Caused by an axial load  Load on the head and forced flexion  Dislocation  Flexion and rotation  Can cause paralysis or death.  Symptoms.
SHOCK. SHOCK Shock is a critical condition that results from inadequate tissue delivery of O2 and nutrients to meet tissue metabolic demand. Shock does.
epidemiology Occurrence per 100,000 2 deaths per 100,000 population due to spinal injury male/female ratio 3/1.
 Spinal cord carries nerve impulses from brain to body & back  Single injury can affect many organs & body functions.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Timby/Smith: Introductory Medical-Surgical Nursing, 11/e Chapter 39: Caring for.
Spinal Cord Injury Gail Lupica PhD, RN, CNE Nurs 211.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Timby/Smith: Introductory Medical-Surgical Nursing, 11/e Chapter 62: Caring for.
Spinal Cord Injury M. Dubois Fennal, PhD, RN, CNS, CNS.
Spinal Shock MARLA SHAW MADISON HENRICHS ANATOMY AND PHYSIOLOGY 2 RED: 3.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 41 Musculoskeletal Care Modalities.
Chapter 7.  Evaluate for suspected spinal injury  Appropriately manage spinal injury  Determine appropriate patient disposition.
Thoracolumbar Fractures
SPINAL CORD INJURY ÖZNUR MOLLA.
Shock It is a sudden drop in BP leading to decrease
Nursing Management: Patients With Neurologic Trauma
Acute Spinal Cord Injury
Chapter 63 Management of Patients With Neurologic Trauma Spinal Cord Injury Dr. Maha Subih.
Presentation transcript:

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 37: Spinal Cord Injury

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Incidence and Causes Incidence –11,000 new cases a year –Estimated 225,000 to 296,000 patients with cord injuries today Age – 16 to 30 (82% male) Cause –Motor vehicle accidents –Violence –Falls –Sports

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Classifications of Spinal Cord Injuries Mechanism of injury Types of vertebral fracture/dislocation Level of injury Type of transection

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Mechanism of Injury Hyperflexion – chin on chest injury Hyperextension – “whiplash” (most common injury) Axial loading – lands on feet or head; compression of cord Rotational injuries – twisting of cord (Refer to Figure 37-1.)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Vertebral Fractures/Dislocations Simple Compressed Wedge compression Teardrop Comminuted (Refer to Box 37-1.)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Level of Cord Injury High cervical (C1-C2) Lower cervical (C3-C8) C1 through T1 called tetraplegic Thoracic (T1-T12) T2 through L1 called paraplegic Lumbar (L1-L5) Sacral (S1-S5) (Refer to Figure 37-2.)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question In a patient with a head injury, spinal precautions must be taken until an x-ray of the head/neck is done. A. True B. False

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. True Rationale: Many injuries of the head involve traumatic injury to the cord, and many cord injuries involve head injuries as well. Until x-rays of the cervical spine are done, the head, neck, and body must be turned as a single unit.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Spinal Cord Syndromes Central cord syndrome –The cord is damaged centrally –Mechanism of injury is usually hyperextension –Damage is seen in the upper arms but the legs and bladder function are preserved Anterior cord syndrome –The cord is damaged anteriorly –Complete motor paralysis below the level of injury –Light touch, sensation, and sense in space (proprioception) are preserved

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Types of Transection A partial transection of the cord can become a complete transection if spinal precautions are not maintained after the injury! Complete transection –Total loss of muscle control and sensation below the level of the injury Partial transection –Retain all or some motor and sensory capacities

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Spinal Cord Syndromes Brown-Séquard syndrome –One side of the cord is injured –Mixed motor/sensory symptoms

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Autonomic Nervous System Syndromes SPINAL SHOCK Immediate - blocked impulses from brain NEUROGENIC SHOCK Distributive shock High cervical and thoracic injuries Loss of sympathetic input ORTHOSTATIC HYPOTENSION Unable to compensate for changes in position HR, SVR, preload, BP, body temp all go down Hypotension, severe bradycardia; loss of ability to sweat below the lesion Drop in BP Lasts for days/months Return of perianal reflex signals the end Transient

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Pathophysiology Cord is located at the level of L1 to brain Primary injury –Cervical spine is most mobile and therefore more prone to injury –The impact area Secondary injury –Continues hours after the trauma

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question In a patient with a traumatic axial loading injury, which of the following would NOT result from a secondary injury to the cord? A. Free radicals are released that alter the sodium- potassium pump mechanisms. B. Edema leads to a higher level of cord injury. C. Vasoactive substances increase permeability, allowing calcium to enter the spinal cord cells. D. Vertebrae compress the cord.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer D. Vertebrae compress the cord. Rationale: The initial injury of axial loading compresses the cord between the bony vertebra, causing primary injury. All of the other choices are a cause of secondary injury.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Initial Assessment of Spinal Cord Injuries Prehospital –Mechanism of injury –Airway, breathing, circulation (ABCs) –Spinal precautions instituted and maintained –Patient usually reports numbness, tingling, or loss of sensation –Check for other related injuries and quick transport In-hospital emergency assessment –Airway and breathing –High-dose steroids (still controversial) –Physical assessment

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Assessment: Body Systems Review Pulmonary –Watch for respiratory function decrease (C1-C5) –Pulse oximetry (continuous) –Respiration rate and pattern –Pulmonary function tests –Other chest injuries –Pre-existing injuries (worsen the prognosis) –Pulmonary edema (too much fluid volume, too fast)

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Patient Assessment: Body Systems Review (cont.) Cardiovascular –Cardiac monitor –Serial BP readings –Monitor for shock syndromes –Foley catheter with hourly outputs –Intake and output Neurological –Level of responsiveness (LOR) –Glasgow Coma Scale (GCS) –Digital rectal exam (DRE) Bladder –Incontinence –Indwelling catheter

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question In a patient who has just been admitted with a high cervical fracture, the physician wants to perform a digital rectal examination (DRE). This test will indicate: A. Whether the patient is at risk for autonomic dysreflexia B. What sexual function will return C. If the cord has a complete or incomplete transection D. If the patient’s bowels are empty

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. If the cord has a complete or incomplete transection Rationale: If the patient can feel pressure when examined, there is a partial cord transection. Although it is important to prevent bowel impaction, autonomic dysreflexia doesn’t occur until after the initial phase of injury. The other answers are irrelevant at this time.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Diagnostic Studies X-ray of the cervical spine first, then others to determine other injuries CT of bony structures MRI of soft tissue injuries Somatosensory evoked potentials

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Ongoing Nursing Assessment and Management Spinal stabilization –Medical management Traction (Gardner-Wells, Crutchfield tongs) Vests & braces (halo vest, Jewett brace) –Surgical management Removal of foreign objects from trauma Laminectomy Problems with postop infections

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Ongoing Respiratory Assessment and Management Respiratory problems are the leading cause of death, so prevention is key. Prevention of atelectasis Trends in pulmonary function tests Coughing and deep breathing (quad cough) Turning (usually at least 3 nurses to maintain spinal alignment) Suctioning Prone positioning

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Question A patient with a spinal cord injury is being suctioned through a freshly inserted tracheostomy. During the procedure, the patient’s pulse rate falls from 98 to 52. The nurse stops the procedure and bags the patient with 100% oxygen. What is the most likely reason why the pulse rate fell? A. The patient is hypoxic. B. The patient no longer needs suctioning. C. The patient has had a vasovagal response to suctioning. D. The patient is going into hypovolemic shock.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer C. The patient has had a vasovagal response to suctioning. Rationale: A bradycardia that occurs during suctioning is a result of the parasympathetic stimulation overriding the sympathetic due to high blockage of the cervical spine. Hypoxia, shock, and the need for suctioning usually are evidenced by a tachycardia.

Copyright © 2009 Wolters Kluwer Health | Lippincott Williams & Wilkins Ongoing Nursing Assessment and Management Cardiovascular stability Role of the pulmonary artery catheter Prevention of DVT, PE Cardiac enzymes/MI monitoring Vasopressors if decreased BP Atropine/pacer if HR falls Neurological management Neuro checks q1h Motor/sensory checks Medication administration Avoid SQ/IM Central line management Pain management