spinal cord injury - southport and ormskirk …...spinal cord injury without fracture scene of...
TRANSCRIPT
![Page 1: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/1.jpg)
F. SelmiNorthwest Regional Spinal Injuries CentreSouthport
Spinal Cord InjuryManagement
![Page 2: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/2.jpg)
** ailment not to be treated **Egyptian Physician 2500 BC
![Page 3: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/3.jpg)
1 year post injury survival
1st World War 10 %
2nd World War 90%
![Page 4: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/4.jpg)
Sir Ludwig GuttmannStoke Mandeville Hospital
1.Systemic Disorder
2. Specialist Centres
3.Long term condition
![Page 5: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/5.jpg)
11 Spinal Injuries Centres:
Stoke MandevilleStanmoreSalisburyOswestrySheffield
WakefieldSouthportMiddlesbroughGlasgowBelfastCardiff
![Page 6: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/6.jpg)
Incidence:
World wide 10 - 20 / million
Age: 20- 40 & 70 years
Sex: 4 : 3 male/ female
![Page 7: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/7.jpg)
Causes:
Traumatic 75%
RTA 45%Accidental falls 34%Sporting injuries 15%Assaults 6%Other 5%
Non Traumatic 25%
Congenital - Spina BifidaNeoplastic - MetastasesInfectious - Tr Myelitis,
TB, AbscessVascular - AVMIatrogenic - Aortic AneurysmDegenerative- Disc
![Page 8: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/8.jpg)
Nervous System:
![Page 9: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/9.jpg)
Vertebral Column24 Vertebrae05 Sacrum01 Coccyx
Spinal cord30 segmentsEnds L1Cauda Equina
Sympathetic Nervous System Thoracic spine
Spinal Reflex arc
Salient Features:
![Page 10: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/10.jpg)
Consequences of Spinal Trauma:
1.Spinal (vertebral) Column
2.Spinal Cord Damage
3.Systemic Failure
4.Socio-economic problems
![Page 11: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/11.jpg)
1.Spinal (Vertebral) Column Injury:
Type of fractures– Wedge– Burst– Fracture dislocation
Level of InjuryCervical 45%Thoracic 40%lumbar 15%
Multiple levels 10%
Spinal Cord injury without fracture
![Page 12: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/12.jpg)
![Page 13: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/13.jpg)
Scene of Accident
Extrication Immobilisation and Evacuation
1.Cervical collarHard collar
2.Cervical extrication device3.Full spine immobilisation
Spinal board Scoop stretcherVacuum stretcher
4.Head immobilisation
![Page 14: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/14.jpg)
Hospital Immobilization / Stabilization
ConservativeBed Rest
Spinal nursing care = Log rolling, bladder / bowel and skin care
Mobilise with a Brace
Surgical fusion /decompressionMonitor blood pressure on mobilisation
![Page 15: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/15.jpg)
Evaluation of Spinal cord Injury Severity or Grade of
Injury
Complete– ASIA A
Loss of all power/Sens.
Incomplete– ASIA B,C,D,E
Preservation of some power and sensation
– Brown sequard– Central cord– Anterior cord– Cauda Equina
Level of Injury
Quadriplegia (Cervical)– paralysis in all 4 limbs
Paraplegia (Thoracic&Lumbar)– Paralysis of trunk and lower limbs
Cauda Equina( Lumbar & sacral)– loss of visceral and lower limb reflexes
![Page 16: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/16.jpg)
Primary Damage Time of Impact
Secondary Damage Immediately following injury
Due to;1 Increased oedema /swelling2. Further disruption of the
cord Causes:
Hypo tensionHypo-oxygenationExcessive movement of fractureCompression of the cordBone frg, disc or haematomaInfectionsElectrolytic balance
Management of spinal cord Damage :
![Page 17: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/17.jpg)
3.Systemic Problems
RespiratoryUrinaryBowelSkinMusculoskeletalCardiovascularSexual and fertilityTemperature regulationPainEndocrine changesElectrolytic changes
![Page 18: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/18.jpg)
Respiratory system :Effect
Inability to breathe or maintain ventilationInadequate respiration or gas exchangeImpaired cough, retained secretions and infections
Impairment depends on;Level of Lesion
C1-2 Mechanical VentilationC3-4 Partial Ventilatory supportC5-8 Self VentilationT1-12 Cough impaired
Associated injuriesPre-morbid chest diseasesSmoking
Therapeutic measures1.Artificial airway ( tracheostomy)2.Mechanical ventilation3. Chest Physiotherapy
Assisted coughing, breathing exercises
![Page 19: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/19.jpg)
Urinary System
Effect Acontractile Bladder > urinary retention
Indwelling / Intermittent catheterAdequate fluid intakeDetrusor relaxant
Complications1. Urinary tract Infections2. Urinary calculi3.Renal impairment
UMN (reflex bladder)Sheath drainage
LMN (Areflexic Bladder)Intermittent catheters
![Page 20: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/20.jpg)
Neurogenic hypotensionUnopposed vagal effect
Effect
1.Hypo tension Systolic 90-110
2.BradycardiaPulse 50-70/ min
Do not need a cardiac pacer maker!!!
Therapeutic measures
1.Hypotension Systolic < 80 mmHg
Urine output < 30 ml / hIV fluids
Urine output > 30 ml / hTed stockings, Abdominal binderInotropic agents
2.Bradycardia Heart rate < 50 / min
Atropine and Prevent hypoxia Avoid frequent vagal stimulatione.g oral suction
Cardiovascular system
![Page 21: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/21.jpg)
Cardiovascular systemContd
Venous thrombosis
40% Deep vein thrombosis5% Pulmonary embolism
ProphylaxisPassive limb exercisesTED stockingsWarfarin / Heparins
![Page 22: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/22.jpg)
Autonomic Dysreflexia( Exaggerated Sympathetic reflex ) common in lesions above T6
CausesBlocked urinary catheter, ConstipationPressure sore, Anal fissure, Ingrowing toe-nail
Warning Mechanism!!
Effect Profound vasoconstriction below level of injuryReactive vasodilatation above
SymptomsHeadache, High Blood pressureSweating/ flushingCerebral stroke/death
TreatmentHead up positionNifedipine / GTNIDENTIFY AND TREAT THE CAUSE
![Page 23: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/23.jpg)
Gastrointestinal system
Effect Autonomic Dysfunction / Paralytic ileus
Onset 0 - 48 hours after injury
Early / Spinal shockNil by mouthNasogastric tubeI V fluids
Parentral nutrition
UMN( reflex bowel) Bowel stimulantsLMN ( areflexic Bowel) Manual evacuation / enema
Late Constipation
ComplicationsStress Ulceration
Gastric protectionOmperazole, Ranitidine
![Page 24: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/24.jpg)
. Skin1.Pressure sores:
Poor skin perfusionLack of sensationUnrelieved Pressure
Sacrum, Ischium, TrochanterOcciput, heels, scapulae. Groin
PreventionAvoid prolonged pressureFrequent turning every 2 hrs
TreatmentProlonged bed restExpensive dressings
ComplicationsInfectionDeath
2.Cellulitis
![Page 25: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/25.jpg)
Increased Tone and Spasms.
Upper motor neuron lesionBelow the level of injuryAlternate warning mechanism for the body
Management:
Physiotherapy / HydrotherapyOral medication e.g Baclofen, DantriumIntrathecal Baclofen
Musculo-skeletal.
![Page 26: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/26.jpg)
Sexual & Fertility:
1. Erectile Dysfunction
ReflexPsychogenic
2. Loss of orgasm
3. Reduced Fertility in Men
Sperm retrieval and preservationIn Vivo Fertilisation
![Page 27: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/27.jpg)
Pain
Musculo-skeletal
Fracture site
Neuropathic
(Nerve Pain)
Carpal Tunnel Syn
Chronic Pain team
![Page 28: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/28.jpg)
Psychological Problems
AnxietyAngerLow moodFrustrationsDepression Behaviour changesRelationship issuesIsolation
Psychotherapy
![Page 29: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/29.jpg)
4.Socio-economic Issues
Life does not stop after SCI
It is different
Family and Care
Accommodation
Employment & Benefits
Mobility / Independence
Recreation
Holidays
![Page 30: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/30.jpg)
Spinal Rehabilitation
Goal is to make maximum use of the remaining functions to achieve the highest degree of independence permitted by the neurological lesion and reintegrate into the community.
Multidisciplinary Team:Medical teamPhysiotherapistOccupational therapistNursing teamPsychologistCase ManagerSocial Services team
![Page 31: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/31.jpg)
Take Home Message
* Systemic Disorder.
* Long term condition.
* Management in the early stages affects the overall outcome.
* Early discussion with Spinal Centres improves long term outcome.
* Life does not stop after SCI it is different
![Page 32: Spinal Cord Injury - Southport and Ormskirk …...Spinal Cord injury without fracture Scene of Accident Extrication Immobilisation and Evacuation 1.Cervical collar Hard collar 2.Cervical](https://reader030.vdocuments.site/reader030/viewer/2022040814/5e5b96b1615370688e0c2d57/html5/thumbnails/32.jpg)
** Successful rehabilitation is one where an individual is admitted as a patient and
discharged as a tax payer.**
Sir Ludwig Guttmann