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Management of Patients with Neurologic Trauma

Spinal Cord Injury (SCI). Definition:Fracture or displacement of one or more vertebrae causing damae to spinal cord and nerve roots with resulting neurological deficit and altered sensory perception or paralysis or both. There will be a total or partial absence of motor and/or sensory function below the level of injury. (Ignatavious and Workman, 2006).

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Management of Patients with Neurologic Trauma

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    1. Management of Patients with Neurologic Trauma Spinal Cord Injury

    2. Spinal Cord Injury (SCI) Definition: Fracture or displacement of one or more vertebrae causing damae to spinal cord and nerve roots with resulting neurological deficit and altered sensory perception or paralysis or both. There will be a total or partial absence of motor and/or sensory function below the level of injury. (Ignatavious and Workman, 2006)

    3. Spinal Cord Injury Primary Injury Secondary injury Secondary reaction Most commonly affected vertebrae C5-C7 T12 L1 Why is early identification and treatment important?

    4. Clinical Manifestations What determines clinical manifestations? What are the two types of spinal cord injuries? How are SCIs classified? What is neurological level? At what level of injury would be need to be concerned with respiratory failure?

    5. More Questions What assessments and diagnostics would you anticipate? What is the primary focus of emergency management?

    6. Medical Management: Acute Phase Goals: Prevent further SCI and observe for signs of neurological deficit High dose corticosteroids (controversial) Research is continuing Medical management: Pharmacologic therapy Respiratory therapy Skeletal fracture reduction and traction Surgical management

    7. Complications of Spinal Cord Injury Spinal or Neurogenic shock Deep vein thrombosis Other: Respiratory failure Pneumonia Autonomic dysreflexia Pressure ulcers Infection

    8. Spinal (Neurogenic)Shock Occurs immediately after injury Result of disruption in pathways between upper/lower motor neurons Characterized by: Flaccid paralysis Loss of reflex activity (areflexia) below level of lesion Bradycardia Paralytic ileus Hypotension Warm, dry extremities

    9. Autonomic Dysreflexia Aka: hyperreflexia Occurs in injuries above T6 Caused by uninhibited sympathetic discharges Life-threatening Key features: Severe, sudden onset of hypertension Bradycardia Severe, throbbing HA Nasal stuffiness Profuse sweating Nausea Blurred vision Piloerection

    10. Nursing Interventions: Acute Phase Promote adequate breathing and airway clearance Improving mobility Promote adaptation to sensory/perceptual alterations Maintaining skin integrity Maintaining urinary elimination Improving bowel function Providing comfort Monitoring and managing potential complications

    11. Long Term Complications Premature aging Disuse syndrome Autonomic dysreflexia Bladder and kidney infections Spasticity Depression Pressure ulcers Heterotopic ossification

    12. Disuse Syndrome Development of contractures is a consequence of disuse syndrome Occurs as a result of loss of motor and sensory function below level of injury

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