Spinal Cord Injuries & disorders
Etiology
Motor Vehicle collisions
Falls
Violence
Sports injuries
Types:
Primary
Secondary
Initial physical disruption of the spinal cord
From processes, ischemia, hypoxia, hemorrhage, & edema
Shocks!
Spinal
Neurogenic (Vasogenic)
Initial response
Characterized by...
Loss of DTRs & sphincter reflexes
Loss of sensation
Flaccid paralysis below level of injury
Often masks post-injury neurologic function!
Occurs in cervical or high thoracic (at or above T6)
Lasts days to weeks!
Characterized by...
Hypotension (< 90)
Bradycardia
Temperature dysregulation
Lasts 1 - 3 weeks!
Lose SNS innervation:
Peripheral vasodilation
Venous pooling
Decreased cardiac output
Levels of injury
Thoracic (12)
Lumbar (5)
Cervical (7)
Sacral (4)
Blunt or penetrating
Ongoing & progressive, causes FURTHER permanent damage!
Patho
Initial destruction, damage to axons, edema & ongoing inflammation, tissue expansion (increased pressure), hypoxia, high levels of lactate metabolites & vasoactive substances = vasospasms & hypoxia with subsequent necrosis
Clinical Manifestations
Respiratory System
Cardiovascular System
Above C3 = Respiratory arrest w/in mins if NOT intubated!
C3 - C5 = Respiratory insufficiency
Above C5 = Intubation at once!
Pt can't cough effectively! At risk for... Aspiration, atelectasis, & pneumonia!