Disruption of autonomic pathways below level of

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disruption of autonomic pathways below level of injury Everything decreases because PNS takes over Spinal Cord Injury Assessment Airway and ventilation : when you suspect spinal cord injury, you stabilize spine first. And then do airway/ventilation. Paralysis of diaphragm and intercostal muscles will result in ineffective breathing patterns 1. C1 to C3: ventilator dependent 2. C4 to C5: may or may not need ventilator. C5 stay alive (any pt with injury below C5, should be able to breathe on own)!! C5 or above, may need ventilator. Phrenic nerve is at C4 & innervates diaphragm. If injury is above, neve cannot feed diaphragm and cannot breathe on own. 3. Below C5: have intact diaphragmatic breathing Neurological: dermatomes (part of skin fed by 1 nerve; like shingles). Injury at T4 = about nipple line and below, they will not have sensation. Important in spinal surgery (spinal fusion/discectomy). Hemodynamic : especially if in neurogenic shock Gastrointestinal tract : risk for ileus, ulcers Bowel or bladder dysfunction : big thing with spinal cord injury. Risk for urinary retention & fecal impaction. Skin : difficult to keep skin intact with pt with spinal cord injury. They still end up with some kind of skin breakdown even with turning. Ex. Christopher Reeves. Psychological: used to moving & talking & now you are paralyzed. Risk for depression. Autonomic Dysreflexia Occurs T6 or above after resolution of spinal shock Intense sympathetic response to painful stimuli below level of injury Have had to pee so badly that it hurts. Normally body can say Okay you can pee in second just hold it. But with injury, bladder can’t send message to brain that bladder is full. So SNS kicks in and you get your CM (HA, HTN, bradycardia). 2 most common causes = Kinked urinary catheter Fecal impaction Severe hypertension, headache, and bradycardia Assess and remove the cause Key: we don’t treat symptoms, we treat cause. If catheter is kinked, unkink it. If fecal impaction, disimpact them. Spinal Cord Injury Management Nursing Management 1. Airway management 2. Cardiovascular stability -Maintain spinal cord perfusion 3. DVT prophylaxis 4. Gastric decompression 5. Skin care 6. Elimination: make sure pt is on bowel/bladder program. Some pts have long term foley or some need to straight cath every few hours. Medical Management Spinal cord stabilization: short term & long term. C-collar (short term) Long term: Halo vest Surgical intervention Medication 1. Glucocorticoids high dose 2. Vasopressors/fluids: if in neurogenic shock 3. Proton pump inhibitors 4. IV fluids
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Critical Care Test 3 (9) BURNS Burn Injury Depth : no longer do degrees. We base it on level. 1. Superficial burns: first degree burns. Sunburns. Don’t do anything. Probably taking stuff for pain, but will heal on own.
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  • Fall '18
  • Traumatic brain injury

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