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Spinal Injury SPINAL INJURY Presented by:- Bhagawati Ray DEFINITION Spinal cord injury (SCI) is damage to the spinal cord that results in a loss of function such as mobility or feeling. TYPES OF SPINAL CORD INJURY Complete Spinal Cord Injuries Complete paraplegia is described as permanent loss of motor and nerve function at T1 level or below, resulting in loss of sensation and movement in the legs, bowel, bladder, and sexual region. Arms and hands retain normal function. INCOMPLETE SPINAL CORD INJURIES Anterior cord syndrome Anterior cord syndrome, due to damage to the front portion of the spinal cord or reduction in the blood supply from the anterior spinal artery, can be caused by fractures or dislocations of vertebrae or herniated disks. CENTRAL CORD SYNDROME Central cord syndrome, almost always resulting from damage to the cervical spinal cord, is characterized by weakness in the arms with relative sparing of the legs, and spared sensation in regions served by the sacral segments. POSTERIOR CORD SYNDROME Posterior cord syndrome, in which just the dorsal columns of the spinal cord are affected, is usually seen in cases of chronic myelopathy but can also occur with infarction of the posterior spinal artery. BROWN-SEQUARD SYNDROME Brown-Sequard syndrome occurs when the spinal cord is injured on one side much more than the other. It is rare for the spinal cord to be truly hemisected (severed on one side), but partial lesions due to penetrating wounds (such as gunshot or knife wounds) or fractured vertebrae or tumors are common. CAUDA EQUINASYNDROME Cauda equina syndrome (CES) is a condition that occurs when the bundle of nerves below the end of the spinal cord known as the cauda equina is damaged. CAUSES: Bullet or stab wound Traumatic injury Electric shock Extreme twisting of the middle of the body Landing on the head during a sports injury Fall from a great height RISK FACTORS Men Young adults and seniors People who are active in sports People with predisposing conditions SIGNS AND SYMPTOMS CERVICAL (NECK) INJURIES Breathing difficulties Loss of normal bowel and bladder control Numbness Sensory changes Spasticity (increased muscle tone) THORACIC (CHEST LEVEL) INJURIES Loss of normal bowel and bladdercontrol Numbness Sensorychanges Spasticity (increased muscletone) Weakness,paralysis LUMBAR SACRAL (LOWERBACK) INJURIES Loss of normal bowel and bladder control (you may have constipation, leakage, and bladder spasms) Numbness Pain Sensory changes Weakness and paralysis ASSESSMENT DIAGNOSTIC TESTS • History collection • Physical & neurological examination • Complete blood count (e.g. Hb, RBC, WBC) • Arterial blood gas level • CT scan & MRI • Myelography MAGNETIC RESONANCE IMAGING (MRI): POSSIBLE COMPLICATIONS Blood pressure changes - can be extreme (autonomic hyperreflexia) Chronic kidney disease Complications of immobility: Deep vein thrombosis Pulmonary infections Skin breakdown Contractures Increased risk of urinary tract infections Loss of bladder control Loss of bowel control Loss of sensation Loss of sexual functioning (male impotence) Muscle spasticity Paralysis of breathing muscles Paralysis (paraplegia, quadriplegia) Pressure sores Shock MEDICAL MANAGEMENT: Whole blood transfusion NS RL Nor epinephrine Epinephrine Dopamine Hydrocortisone SURGICAL MANAGEMENT • Occasionally, surgery is done immediately if the spinal cord appears to be compressed by a herniated disc, blood clot or other lesion. • This is most commonly done for patients with an incomplete SCI or with progressive neurological deterioration. • Even if surgery cannot reverse damage to the spinal cord, surgery may be needed to stabilize the spine to prevent future pain or deformity. • The surgeon will decide which procedure will provide the greatest benefit to the patient. NURSING MANAGEMENT: • Immobilisation & reduction of dislocation • Administered oxygen • Provide skeletal traction • No body part should be twisted or turned. • Maintain nutritional status. • Use spinal board to shift the patient. Spinal board REHABILITATION Cognitive Rehabilitation Therapy Speech Therapy Mental Rehabilitation Physical Exercise Occupational Therapy Nursing diagnosis:- Impaired physical mobility related to loss of motor function Fluid volume deficit related to decrease LOC Risk for injury related to loss of motor function Urinary retention related to level ofinjury Risk for Impaired skin integrity relatedto trauma Knowledge deficit regarding thetreatment modalities and current situation. Anxiety related to outcome of diseases as evidenced by poor concentration on work, isolation from others, rude behaviour THANK YOU.
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