Management of Patients with Neurologic Trauma Spinal Cord Injury
Spinal Cord Injury (SCI)
Fracture or displacement of one or more vertebrae causing damae to spinal cord and nerve roots with resulting neurological deficit and altered sensory perception or paralysis or both. There will be a total or partial absence of motor and/or sensory function below the level of injury. (Ignatavious and Workman, 2006)
Spinal Cord Injury
Most commonly affected vertebrae
Why is early identification and treatment important?
What determines clinical manifestations?
What are the two types of spinal cord injuries?
How are SCIs classified?
What is neurological level?
At what level of injury would be need to be concerned with respiratory failure?
What assessments and diagnostics would you anticipate?
What is the primary focus of emergency management?
Medical Management: Acute Phase
Prevent further SCI and observe for signs of neurological deficit
High dose corticosteroids (controversial)
Research is continuing
Skeletal fracture reduction and traction
Complications of Spinal Cord Injury
Spinal or Neurogenic shock
Deep vein thrombosis
Occurs immediately after injury
Result of disruption in pathways between upper/lower motor neurons
Loss of reflex activity (areflexia) below level of lesion
Warm, dry extremities
Occurs in injuries above T6
Caused by uninhibited sympathetic discharges
Severe, sudden onset of hypertension
Severe, throbbing HA
Nursing Interventions: Acute Phase
Promote adequate breathing and airway clearance
Promote adaptation to sensory/perceptual alterations
Maintaining skin integrity
Maintaining urinary elimination
Improving bowel function
Monitoring and managing potential complications
Long Term Complications
Bladder and kidney infections
Development of contractures is a consequence of disuse syndrome
Occurs as a result of loss of motor and sensory function below level of injury