SPINAL CORD INJURY

Mrs. Zaida Zaracena

Any patient with head injury must be
presumed to have a spinal injury unless
proven otherwise.
SPINAL CORD INJURY-(SCI) An
injury/damage to the nerves within the
spinal canal caused by trauma to the
vertebral column, thereby affecting the
spinal cords ability to send & receive
messages from the brain to the bodys
system that control sensory, motor &
autonomic function below the level of
injury.
Trauma to the spinal cord causing partial or
complete disruption of the nerve tracts &
neurons resulting to cord edema and
necrosis due to compromised capillary
circulation and venous return.
TYPES OF SCI
1.Completenerve damage obstructing
every signal coming from the brain to the
body parts below the injury.
The patient lacks sensory function,
proprioception (position sense) voluntary
motor activity below the level of spinal
cord damage. Has worst prognosis of
recovery
2.Incomplete nerve damage where some
residual motor & sensory function remains
intact below the level of cord injury. Has
good chance for recovery.
CLASSIFICATION OF INCOMPLETE SCI
1.BROWNE SEGUARD SYNDROME The
extremities that can move cannot feel & those
that can feel cannot move. Only one side of the
spinal cord is damaged. On the side of the body
with cord lesion-patient loses motor function &
proprioception but can sense pain &
temperature. On the opposite side of the body,
motor function & proprioception are preserved
but pain & temperature sensation are lost.There
is greater ipsilateral loss of proprioception &
motor function
2. Anterior cord syndrome -The most
devastating & most severe type of SCI. It
is due to the disrupted blood flow through
the anterior spinal artery damaging
anterior portion of gray & white matter of
the spinal cord. Only the dorsal column
that control proprioception is fully
preserved
3. Central cord syndrome- Center of spinal
cord is damaged. Upper extremities are
more impaired than the lower because
they are controlled by the central portion
of the cord. Usually involved cervical
lesion
CAUSES
1.Motor Vehicular accident
2.Falls
3. Sporting & industrial accidents
4. Gun shot wound
5.Stabbed wound
6. Trauma
a) Acceleration caused by moving object
striking head (Baseball bat)
b) Deceleration - Head moving striking solid
object
c) Rotational Force Hyper extension,
hyperflexion, lateral twisting
D) Penetrating missile- blunt object
MECHANISM OF INJURY
1. Hyperflexion- no protective gear/seat belt
2. Hyperextension- head snaps back or whiplash
injury resulting to tear to anterior longitudinal
ligaments
3.Distraction- stretch injury of vertebral column
resulting to cord rupture (Hangmans
Fx)
4.Axial Loading or vertical compression- falls
where individual land on his head, buttocks or
feet. (Diving injury)
5.Penetrating trauma- contuse or transect. Shock
wave from high velocity
Signs & symptoms varies on 2 factors
1.The location of injury
2. Severity of injury
It maybe,
1.Pain or an intense stinging sensation caused by
damage to the nerve fibers in the spinal cord
2.Loss of movement
3.Loss of sensation, including the ability to feel heat,
cold & touch
4.Loss of bowel control
5.Exaggerated reflex activities or spasms
6.Change in sexual function, sexual sensitivity &
fertility
7.Difficulty in breathing, coughing or clearing
secretions from the lungs
Emergency signs & symptoms
1.Fading in and out of consciousness
2.Extreme back pain or pressure in the neck, head
or back
3.Weakness, in coordination or paralysis in any
part of the body
4.Numbness, tingling or loss of sensation in the
hands, fingers, feet or toes
5.Loss of bladder or bowel control
6.Difficulty with balance & walking
7.Impaired breathing after injury
8.An oddly positioned or twisted neck or back
LIFE THREATENING CONDITION IN SCI
1. Airway- jaw thrust maneuver to open airway.
No head tilt or chin lift. No maneuver to flex
or extend neck. Stabilize head in normal
position. If intubated- give 100% oxygen &
ventilate- to prevent hypoxia & Bradycardia
2. Breathing- Keep in mind that diaphragm is
innervated by C3,C4 & C5 levels. Lesion
above C5 will cause partial to complete loss
or diaphragmatic paralysis. Intercostal
muscles are paralyzed by lesion above T1,
C2 C8. Abdominal muscles are paralyzed by
lesion above T11 to T1
3. Hemorrhage & Neurogenic shock- It
reflects the dominance of the
parasympathetic nervous system that
develops when the sympathetic
nervous system cannot send impulses
pass a spinal cord lesion resulting to
1) Vasomotor tone is loss producing
hypotension due to vasodilatation
2)Increase vagal tone causing bradycardia
3)Hypothermia
Neurogenic shock- Loss of vasomotor tone
& impairment of autonomic function
lasting for 2 days to 3 weeks after injury.
Spinal shock Loss of spinal reflexes
resulting to flaccid paralysis below the
level of injury. It lasts for 2 weeks to 2
months. In the end flaccid muscles
become spastic.
Bradycardia- poses serious threat to patients
circulatory function due to
1.Hypoxia
2.Hypothermia
3.Vagal stimulation
IMPLICATION
1. Patient must be well oxygenated
2. Maintain body temperature
3. Atropine readily available at the bedside
A - airway
B - breathing- C3,4 & 5
C - circulation
D - disability- responsiveness, alertness
gross sensory & motor deficit
E - exposure- look for exit & entrance of
bullet
F - Fahrenheit
G - get vital signs
H - head to toe assessment
I - intervene
COMPLICATIONS OF SCI
1. Pulmonary complications- Foremost & earliest
cause of death due to paralysis of accessory
muscles & diaphragm resulting to
hypoventilation/atelectasis
Nursing Care
1. Chest physiotherapy with postural drainage.
Suction every 2-4 hours
Incentive spirometer
2. Assess breath sounds & ABG results
3. Chest X ray
4. Be prepared for intubation & mechanical
ventilation PRN
2. Pulmonary Embolism Due to possibility
of developing DVT
1. Loss of skeletal muscle pump
2. Hypercoagulability of blood
Implication
Perform ROM several times daily
3. Orthostatic Hypotension- Elevate head
slowly
4. Autonomic Dysreflexia- It is a
hypertensive crisis that occur from noxious
stimuli during rehabilitation due to visceral
distension from distended bladder &
impacted rectum. Occurs after period of
spinal shock resolution
5. GI function- paralytic ileus May insert
NGT to decompress gastric content
For GI bleeding give H2 Blocker
Tagamet - Zantac
For constipation give suppositories
6. Spinal Shock/Neurogenic shock- A sudden
depression of reflex activity in the spinal
cord below level of injury (areflexia)
TREATMENT
1. Steroid administration-(Methylprednisolone Na
Succinate) within 8 hours Golden Period) this
causes hyperglycemia- monitor blood glucose
level
2. Mannitol Osmotic diuretic to reduce cord
edema
3. H2 Blocker- Decrease or neutralize effect of
steroid that increases gastric secretions
4. Muscle relaxant
5. Calcium Supplement
ORTHOPEDIC MANAGEMENT
1. REDUCTION - realign through application
of skeletal traction. Too much pull can
cause distraction injury gardner wells,
tongs or halo traction 5 to 10 pounds of
weight are added to each vertebral
interspace beginning at C1- It reestablish
spinal alignment.
2. Fixation - Stabilizing vertebral fracture
with wires, plates & other hardware
3. Fusion- Attaching injured vertebra to
uninjured vertebra with the use of bone
graft and steel rods to help maintain
structural integrity.
4. After surgery- Immobilization is necessary
Halo vest
Body cast
Special fitted braces
Rigid cervical collar
5. Halo fixation device- A static traction
devise attach to vest or cast when spine is
stable allowing increase client mobility
Halo fixation device
Nursing Care
1. Monitor neurologic status
2. Never turn client holding on halo vest
3. Assess tightness of jacket by ensuring
that one finger can be placed under jacket
Nursing care of a patient with a fracture,
whether casted or in traction, is based
upon prevention of complications
while healing
When assessing a patient with a fracture,
check the "5 P's"--pain, pulse,pallor,
paresthesia, and paralysis.
(1) Pain -Determine where the pain is
located and if it is worse or
better?Worsening pain may indicate
increased edema, lack of adequate blood
supply, or tissue damage.
.(2) Pulse. Check the peripheral pulses,
especially those distal to the fracture site.
Compare all pulses with those on the
unaffected side. Pulses should be strong
and equal.
3) Pallor. Observe the color and
temperature of the skin, especially around
the fracture site. Perform the capillary refill
(blanching) test.
(4) Paresthesia. Examine the injured area
for increase or decrease in sensation.
(5) Paralysis. Check the patient's mobility.
Can he wiggle his toes and fingers? Can he
move his extremities? All nursing
assessment findings should be documented
in the patient's chart so that comparison can
be made with notes made at both earlier
and later dates.





In addition to the five P's mentioned
above, the patient's level of consciousness
and temperature should be checked
regularly. Mental status changes and
temperature elevation could indicate the
presence of infection. Reposition the
patient as necessary to relieve pressure
areas.
Check all dressings, bandages, casts,
splints, and traction equipment to ensure
that nothing is causing constriction or
pressure. Frequent and thorough checking
and observation on the part of the nursing
staff will promote healing and prevent
complications.
Elizarov
Leg braces
Hip spica
External fixator