Taking a Look at Spinal Shock

Autonomic dysreflexia is a complication of spinal cord injuries. “It is a massive, uncompensated cardiovascular reaction mediated by the sympathetic nervous system” (Lewis, 2014, p.1784). There are many factors that need to be explored in relation to the complication of autonomic dysreflexia in spinal cord injuries. These factors include etiology, pathophysiology, clinical manifestations, diagnostics, and collaborative care.

In the book clinical manual of emergency pediatrics the Cain and Gershel state "spinal cord injury is sometimes overlooked during the initial evaluation of the severe brain injury patient" (Crain & Gershel, 2004. p.642). The head in humans is connected to the neck bone, therefore injury to the cervical spine should be ruled out. To evaluate this, ask the child if any numbness or tingling in any body part or does it feel like pins or needles. The toes or sole of the feet should be touched to detect sensation then ask "can you feel your toes being touched." "Paresthesia is an abnormal sensation" says Jarvis (2002. p.670).The goal is to detect any spinal cord injury. If there are any indications of a suspected traumatic brain injury a CAT scan of the brain should be done as long as no spinal injury is detected. The nurse should continually be alert to the signs and symptoms of increases in intracranial pressure, such as restlessness, nausea and vomiting, altered mental status, and changes in vital signs. Monitor closely for seizure activity.

After researching about paraplegic and quadriplegic, it has been determined how they occur and in what parts of the body they affect. According to John Hopkins Medical, if a person suffers with paraplegic or quadriplegic, it is caused by damage to the spinal cord. To determine whether a person has a spinal injury, doctors will use clinical signs to help determine the severity of the injury. When the spinal cord has been injured, the patient might feel pain, and some disorders; such as motor or sensory. When this occurs, it allows the doctor to determine the cause of the injury, however; most spinal injuries are caused by traumatic accidents. The two

Carey reported that she experienced occasional numbness of the upper extremities and that she would occasionally drop objects from both hands. Upon physical examination, Dr. Abiera noted that Ms. Carey’s range of motion of the cervical spine was decreased on flexion and tenderness on palpation of posterior cervical muscles with spasms and trigger points was present. In addition, Dr. Abiera noted that the range of motion of lumbar spine was within normal range, however there was still some tenderness on palpation of thoracic paraspinals muscles.

The limited space within the vertebrae actually plays an important roll in spinal cord injury. Once the initial injury occurs the body, as with every other part of the body, tries to protect the injured area with swelling. But the swelling occurs within the small confines of the spinal column and causes further damage to the surrounding tissue. It has only recently been discovered how much of an impact this secondary damage has. One of the areas of crucial ongoing research is on what kind of window of opportunity medicine has in treating these types of injuries and still attaining the best recovery.

Chronic Neuropathic Pain after Spinal Cord Injury: Spinal cord injury (SCI) affects up to 500,000 people every year around the world (Singh et al., 2014) with devastating physical, psychological and social consequences. SCI not only damages motor systems, it also directly affects sensory systems, causing chronic, debilitating neuropathic pain. The incidence of neuropathic pain after SCI is extremely high, with at least half and up to 90% of SCI individuals experiencing neuropathic pain, described as paroxysmal pain that can be continuous and may be evoked by any sensory stimulus, not necessarily painful. Current pharmacological interventions offer minimal, transient relief to a minority (30%) of sufferers of SCI-induced neuropathic pain (Cousins, 2012). Current treatment strategies utilize conventional drugs for chronic pain, which only address pain symptomatically and cannot provide lasting relief or prevent relapse of symptoms, leading to drug dependency and further reducing quality of life for SCI patients. Due to the myriad events that take place after SCI, delineating the causes of neuropathic pain development is difficult. Neuropathic pain in general, and more so in SCI, has an inherent degeneracy in mechanisms, which is likely why targeted pharmacological treatment approaches often fail to provide significant relief.

Symptoms for a spinal cord injury vary depending on the location of the injury. Spinal cord injury causes weakness and loss of feeling at, and below the injury. How severe symptoms are depends on whether the entire cord is severely injured or only partially injured.

In an individual with quadriplegia due to SCI, injury is usually sustained to one or more of the vertebral structures of the spinal column between the levels of C1 and T1, causing damage to one or more of the first eight spinal nerves. When naming the level of injury, the specific vertebral segment involved will be identified by the first letter in which it is named followed by the last spinal nerve root which remains intact; for example, if an individual has a fracture to a cervical vertebra and innervation of the triceps remains, the injury would be identified as a C7 injury. The American Spinal Injury Association (ASIA) developed a guide to help identify the level of injury called the ASIA International Standards for Neurological Classification

Spinal cord injury is an injury to the spinal cord which results in paralysis below site of injury.

A spinal cord injury does not occur in a single moment. Instead damage will continue to ensue for days to weeks after the initial injury. The initial impact and injury causes the immediate damage and death of oligodendrocytes and motor neurons. However, another wave of damage is caused by the secondary processes that occur after the injury. The spinal cord is a bundle of nervous tissue and neurons protected by the vertebral column that transmits electrical synapses, or messages, from the brain to the rest of the body. It is composed of three layers of membranes and is protected by the bony vertebrae that make up our vertebral column. The spinal cord upon impact will swell and secrete chemicals which will cause an inflammatory response and will kill neighboring cells increasing the amount of functioning lost throughout the body. The swelling can also cut off the blood flow to the

There are an entire host of conditions and situations in which individuals may suffer a fragmented neck or back that will cause a serious spinal injury. From sports injuries to car and motorbike crashes, slips, trips and attacks, calamities at work, medical neglect, even infections of the spinal nerve cells, cysts and tumors that press on the spinal cord and impair it. The hardship of having suffered a serious spinal injury doesn't have to be the end of the road for an active individual. As the door on a former life closes, so one to a new one opens. With the right sort of support and supervision, many sufferers can in fact recuperate enough flexibility to permit them to lead active and satisfying lives, and for many individuals it essentially

Patient Description: Patient is a 46 yr old male; 3 months post traumatic spinal cord injury. Patient is dependent and bed bound for majority of the day. Patient presents with BUE weakness and poor control and sensation in BLE. Patient also demonstrates poor trunk control and has extensive pain in LUE.

Based on the neurological exam, Mr. Hendrix injury occurred primarily in the lumbar region. The Lumbar region which is located around the lower back of the body, which is also the area where Mr. Hendrix said he first felt pain immediately following the incident. The lumbar region controls most of the lower portion of the body. Lumbar 1 -3 affected his hip flexion, Lumbar 4 inhibited Mr. Hendrix’s ability to extend his knee, and Lumbar 5 affected his ability to dorsiflex his ankle. The reason that the spinal cord effects this region is due to a bundle muscle fibers being intertwined with those sections, also known as Myotome. This injury is recognized in the medical industry as Paraplegia.

According to Chiles and Cooper (1996) spinal injury should always be suspected in patients with severe systemic trauma, patients

Spinal immobilisation is considered for utilization for two specific patient groups: (1) unconscious injury victims and (2) any patient with a motion injury. These two specific groups lead to the perception that these patients have a possible spinal injury and immobilisation is required. (M.J.Sanders, 2010) Applying clear, clinical guidelines for evaluating a possible spinal injury in a patient can support the accuracy of pre-hospital assessment. The following signs and symptoms may assist in the decision of full spinal immobilisation: