8. Onset
• syndrome of massive imbalanced reflex
sympathetic discharge in patients with SCI above
the splanchnic outflow (T5–L2).
• May appear within 2–4 weeks postinjury.
• Classically occurs in patients with neurological
complete SCI, although it may occur in patients
with incomplete SCI.
18. Important Levels to Remember
• T6 and above: individuals with SCI are considered to be
at risk for
– Autonomic Dysreflexia
– Orthostatic Hypotension
• T8 and above: if lesion above T8, patient cannot
regulate and maintain normal body temperature.
– (Note: an easy way to remember this level is to
spell the word temp eight ture.)
– Central temperature regulation in the brain is
located in the hypothalamus.
19. • 某病患因為重病臥床太久，薦骨部位出現褥瘡
，檢測時發現表皮有約 2 公分平方的水泡，邊
緣泛紅，未看到真皮層的損傷或化膿。其褥瘡
依據照護及研究（ health care policy and
research ）分類是屬於那一級？ (99-2-61)
1.stage 0
2.stage I
3.stage II
4.stage III
20.
21. MECHANISMS OF DEVELOPING A
PRESSURE ULCER
• 1. Ischemia: lack of blood supply to the tissue
– Frequently associated with hyperemia in the surrounding tissue.
– Increased local O2 consumption occurs.
• 2. Pressure:
– Prolonged pressure over bony prominences, exceeding
supracapillary pressure (70 mmHg pressure) continuously for 2
hours results in occlusion of the microvessels of the dermis with
subsequent tissue ischemia.
• 3. Friction (Shearing Forces):
– Friction mechanically separates the epidermis immediately above
the basal cells.
25. Surgery Intervention
• Musculocutaneous flap: most common and most often
recommended in severe pressure ulcers in SCI.
– Skin transferred with underlying muscle/blood vessels
• Rotation flap:
– Semicircular flap rotating about a pivot point to close a
triangular defect
• Transposition flap:
– Rectangular flap rotates about its base to fill an adjacent
defect
• Advancement flap:
– Moved into a defect without lateral or rotational
movement
26. Postop Management for
Musculocutaneous Flap Procedures
• Strict bed rest—at least 3–4 weeks
• Vigilant pressure relief and avoidance of shear
forces
• Air-fluidized bed
– Temperature adjustable, good pressure relief,
absorption of wound fluids away, bacteriostatic
capabilities of the beads
• Sitting time: if no problem after immobilization
– Slowly increased: start 15 minutes daily and increase
by 15 minutes BID.
– Monitor flap closely afterwards.
29. Female Infertility After SCI
• Immediately following SCI, amenorrhea occurs in
85% of women with cervical and high thoracic
injuries and 50–60% of women overall.
• However, 50 and 90% (respectively) have return
of menstruation within 6–12 months after injury.
• SCI does not affect female fertility once menses
return.
30. Pregnancy
• The likelihood of pregnancy after spinal cord
injury is unchanged, since fertility is
unimpaired.
• Pregnant women with SCI may develop:
– Pressure ulcers
– Recurrent UTIs
– Increased spasticity
– Decreased pulmonary function
31. – Autonomic dysreflexia: may be the only clinical
manifestation of labor
– Uterine innervation arises from T10–T12 level. Patients
with lesions above T10 may not be able to perceive
uterine contractions.
• Treatment of choice is epidural anesthesia
• Epidural should continue at least 12 hours after the delivery or
until the dysreflexia resolves
• Need to distinguish from preeclampsia
– Slightly increased incidence of preterm labor
– Constipation
– Thromboembolism
– Leg edema
34. SEXUAL DYSFUNCTION AFTER SCI
Male Sexual Act
•Male erectile and ejaculatory functions are complex
physiologic activities that require interaction between
vascular, nervous, and endocrine systems.
•Erections are controlled by parasympathetic nervous
system.
•Ejaculations are controlled by sympathetic nervous
system.
35. Male Infertility After SCI
• Fertility in men after SCI is impaired. As mentioned above,
two major causes are ejaculatory dysfunction and poor
semen quality.
• Poor semen quality is secondary to:
– Stasis of prostatic fluid
– Testicular hyperthermia
– Recurrent UTIs
– Abnormal testicular histology
– Changes in hypothalamic-pituitary-testicular axis
– Possible sperm antibodies
– Type of bladder management
– Long-term use of various medications
