Spinal Cord Injury Management

Send us a text

Ever wondered how to expertly navigate the complex world of caring for patients with spinal cord injuries? Fear not, because in our riveting discussion with Dr Hobbock, we unpack everything you need to know, from recognizing the telltale signs of spinal shock and autonomic dysreflexia to implementing effective management strategies. Master the use of corticosteroids, the role of traction, and the essential monitoring techniques to ward off further injury or infection. 

It's not just about the medical side of things though. We will also tackle the psychological impacts of these debilitating injuries on patients. We'll help you understand the guilt that often accompanies spinal cord injuries and how best to provide emotional support. Learn how to connect your patients with the right support groups, therapists, and case managers or social workers. Don't miss out on this treasure trove of key insights and practical tips that will arm you with the knowledge you need to provide top-notch care for patients with spinal cord injuries.

Episode Transcript

Speaker 1 (00:02):
Hey and welcome to Nursing with Dr Hobbock.
Today I'm thinking about spinalcord injuries, just moving on
in this series on neurologicalconditions.
So spinal cord injuries,there's really two types.
You have complete, incomplete,or you can classify them by the
mechanism of injury, which canbe direct or indirect.

(00:24):
A direct injury is going to befrom a blunt force trauma to the
spine or a penetrating injury.
So the five primary mechanismsthat can result in a spinal cord
injury are hyperflexion, andthat's like a sudden, forceful
acceleration of the head forward.

(00:44):
Hyper extension when, say, acar is hit from behind and the
patient's chin is struck, thehead suddenly accelerates and
then decelerates.
We also have vertebralcompression or axial loading, so
this would be like a divingaccident.
Excessive rotation this is whatyou see in the movies when they

(01:08):
go up and they twist somebody'shead and break their neck.
That's an excessive rotation.
And then we have penetratingtrauma.
We can also have injuries tothe spinal cord via a secondary
injury.
So hemorrhage, ischemia,hypovolemia, impaired tissue
perfusion from some other reason, like neurogenic shock and

(01:28):
local edema on the spine, canalso cause spinal cord injury.
When we perform that initialassessment, we really want to
just get the information aboutthe injury as much as
information about the injury aswe can.
Where did it happen?
What was the position of thepatient right after the injury,
or did they have changes rightafter?

(01:49):
Any changes that have happenedsince then?
Have they been immobilized?
Did anybody use an immobilizer?
What kind of treatment has beengiven on the scene?
Their medical history, ofcourse Do they have osteoporosis
or arthritis of the spine, anydeformities, cancer, previous
injury and, of course, anyhistory of respiratory issues?

(02:10):
We're going to classify thesespinal cord injuries based on
the level of vertebrae.
So we'll say we have the C5, c6, c7, so the cervical vertebrae,
c5, c6, and C7.
T12 is another common place andL1 are the most common places

(02:31):
where we see spinal cordinjuries.
Of course, we're still usingthe ABCs for these patients and
we're going to use that GlasgowComa Scale that we talked about
in the previous episode andwe're watching out for spinal
shock.
This is something that's goingto happen right away.
It's the cord's response to theinjury.
So the patient's going to havecomplete but temporary loss of

(02:52):
motor, sensory, reflex andautonomic function and that's
going to last less than 48 hoursbut could continue for a couple
of weeks.
This is not the same asneurogenic shock.
So keep that in mind.
You need to, of course, bedoing neurological assessments
frequently and then, especiallyif the injury is C3 to C5,
you're going to be doingrespiratory assessments because

(03:15):
the cervical plexus innervatesthrough the diaphragm.
So C3 to C5, think aboutrespiratory status.
If I go back real quick to thatspinal shock, that's going to
last 48 hours to a couple ofweeks.
We're not going to know if thispatient has permanent damage
for at least a week.
We're going to have to wait forsome of the swelling to go down

(03:37):
at edema so that we can tellwhether or not it's permanent.
They may have more loss ofsensation, loss of function,
immediately following the injurythan they will later on in life
.
One of the classic things thatyou need to know about for
spinal cord injury is autonomicdysreflexia.
It's sometimes abbreviated AD.
Autonomic dysreflexia refers toa potentially life-threatening

(04:03):
condition where we have astimuli, usually a visceral or
cutaneous stimuli that causes asudden, massive, uninhibited
reflex sympathetic discharge.
This patient usually has a highlevel spinal cord injury and
their signs and symptoms will bea significant rise in systolic

(04:24):
and diastolic blood pressure,accompanied by bradycardia.
Blood pressure is going toskyrocket, heart rate goes down.
We'll see profuse sweatingabove the level of the spinal
cord injury, especially the face, neck shoulders, goose bumps
below the level of injury.
They may have some flushing inthe face and neck shoulders.

(04:45):
They may have blurred vision,spots in their visual field,
nasal congestion, severethrobbing headache and then they
may have pallor below the levelof injury or they may have a
feeling of apprehension.
So keep autonomic dysreflexiain the forefront of your mind.
That one is a classic forquestions as far as nursing.

(05:05):
So keep that in mind.
And the first thing that you'regoing to do if the patient has
autonomic dysreflexia is sitthem upright and check their
bladder.
Notice that full bladder orbowel can actually be the
visceral stimuli that triggersthis.
So if you notice that in thepatient, sit them upright, check
the bladder, see what's goingon there.

(05:27):
Obviously, these patients needto be stabilized anytime you
have to transfer.
So make sure you're log rollingto keep that spine in alignment
.
You're using the cervicalcollar as needed.
We wanna maintain their airwayand we might actually see
skeletal traction.
Remember that skeletal tractionis where the pins go into the
bone and then we apply tractionto that Skeletal traction.

(05:51):
We might see skull tongs or ahalo ring.
You can look those up.
The most important parts abouttraction is that the weights
hang freely, you don't addweight, you don't remove weights
and you keep the pin sitesclean at least once a shift and
monitor them for signs andsymptoms of infection, aerithema
, edema, exudate, those kinds ofthings.

(06:13):
In the very beginning of aspinal cord injury we might see
high doses of corticosteroids tohelp control that edema in the
first eight to 24 hours.
We also might see a strikerframe or a really firm mattress
with a board underneath for thespinal cord patient to try to
support that spine.
And if the patient has a highcervical injury, again you're

(06:35):
monitoring that respiratoryfunction for respiratory failure
.
We could see further loss ofsensory or motor function below
the injury.
That can indicate additionaldamage due to swelling and
should be reported right away.
So it's something you wannareport, stat and we're watching
out for that spinal shock wherewe have that complete loss of

(06:57):
all reflex and even deep tendonreflexes, motor, sensory and
autonomic activity below thelevel of the injury and that's
actually a medical emergency.
We're monitoring for hypotensionand bradycardia and bladder and
bowel distention.
The patient could develop acuteparalytic ilius, so lack of
gastric activity.

(07:17):
So we wanna assess bowel soundsfrequently.
If needed, we're gonnaimplement gastric suction.
So you're gonna put in probablya Salem sump to low
intermittent suction to keepthat decompressed and we might
use a rectal tube to release anygaseous distention.
On that end, we made suction,but you've gotta be really
careful that you don't triggerthe vagus nerve, because that

(07:39):
can cause cardiac arrest.
We wanna make sure that we areencouraging deep breathing,
moving the patient side to sideat least every two hours, if not
every hour.
Encouraging fluids, making surethat the patient stays well
nourished we're just watchingout for all of those
complications of immobility thatwe should already know.

(07:59):
So, scds, compression stockingswe wanna get the patient moving
in the bed.
Deep breathing, incentives,barometry, if that's possible
those things to keep an eye on.
This patient is likely to go toa rehabilitation facility.
We definitely wanna encouragethat.
The folks at the rehabs areamazing at helping improve

(08:21):
muscle strength and coordinationand helping the patient to find
out how they're gonna be ableto get along at home with their
new life.
Finally, we need to think aboutpsychosocial.
Just because a patient has aspinal cord injury doesn't mean
that well, whoop, we're gonnagive up on you now.
We wanna make sure that we'reallowing the patient the
opportunity to discuss theiremotional reactions, talk about

(08:45):
their body image, their role,performance, self-concept.
These things can definitelychange.
Many patients who have spinalcord injuries are young men who
can feel guilty about havingengaged in a high-risk behavior.
There's a simulation that werun where the patient is a
younger male who's gotten into amotorcycle accident and one of

(09:06):
the things that we like to havehim say is mom told me I
shouldn't be riding themotorcycle without a helmet.
So you're gonna wanna give themthe opportunity to talk through
these feelings.
Get them in touch with asupport group or therapy if
needed, contact your socialworker, case management for
assistance or do what you canfor the patient.

(09:27):
That's really all I have forspinal cord injuries for today.
I hope that that's helpful.
Mostly the key points for youguys, and thanks for hanging out
with me here on Nursing with DrHobbock.
I'll see you next time.