General Discussion

• Spinal Cord Injuries

• Neurogenic Shock

• Autonomic Dysreflexia

CNS-Central NS

• Brain

• Spinal Cord

Levels of the Spine

• 33 Spinal Nerves

• Breakfast Lunch and 2 Dinners

Cervical-7

• C1 & C2-Atlas & Axis

• C3, 4, and 5 keep the diaphragm alive (Phrenic Nerve)

• C6, C7-Shoulders, arms, hands, fingers

Thoracic-12

• Intercostal muscles, chest wall, abdomen

Lumbar-5 (L for Lower extremities)

• Hips

• Legs

• Knees

• Feet

Sacral-5 ("S" is for sex and shitting)

• Sexual function

• Bowel and bladder control

2 types of SCI

• Complete SCI (Transection)

• Incomplete SCI

Function of the Spinal Nerves

• Motor

• Pain

• Vibrations

• Temperature

• Proprioception

Tetraplegia=Quadriplegia

Incomplete SCI

• Central Cord Syndrome

• Anterior Cord Syndrome

• Brown-Sequard Syndrome

Central Cord Syndrome

• Center of the cord is damaged

• Cervical Level

• Hyperextension Injury

!!!!!The guy who CAN walk into a bar, but he CANNOT take a drink!!!

• NO LOSS of function to the Lower extremities

• LOSS of function to the Upper extremities (Loss of Motor/Sensation)

Anterior Cord Syndrome

• Front of the cord is damaged

• Occurs at the Cervical level

• Hyperflexion injury

!!!!The guy who CANNOT walk into the bar, but he CAN take a drink!!!

• NO loss of function to the Upper extremities

Brown Sequard Syndrome

• A lateral injury-1 sided of the cord is damaged

• Cervical or high thoracic level

• Penetrating trauma

• Ipsilateral-The side of the injury

• Contralateral-The opposite, uninjured side

Diagnostics

• Spinal Xray-to R/O vertebral fractures

• CT scan

• MRI

• Assess for skin breakdown

• Assess for bowel and bladder function

• Foley Cath

• Pain Management

• Keep the neck in neutral alignment

• High dose corticosteroids

_________________________________________________________

Neurogenic Shock

• Occurs in SCI above the level of T-6

• Unable to compensate

• Bradycardia

• Hypotension

• Unable to shunt blood=Dry/Warm/Flushed

Spinal Shock-goes away in 48 hours

Neurogenic Shock=Distributive Shock (Vessel Problem)

• IV Fluids

• Levophed (Nor-epinephrine)-Pure vasopressor=Strong vasoconstriction

Autonomic Dysreflexia

• Occurs in SCI above the level of T-6

• Occurs after Neurogenic Shock

• A massive overstimulation of the sympathetic NS, due to a noxious stimulus

• Full Bladder-most common

• Fecal impaction

• Tight clothing

• Pressure areas

ICU Treatment

• Immediately sit the pt. up!!!!!

• Assess for the stimulus causing this=Foley Cath, Fecal disimpaction, reposition, remove clothing

• Hydralazine, Nipride, Nicardipine=Cardene, NTG patch/paste

Bipolar Leads=Limb Leads

• Leads I, II, III

• + always looks to -

Augmented Leads

• AvL

• AvR

• AvF

Precordial Leads

• Leads V1-V6

Hemodynamics

Cardiac Output

• The amount of blood the heart pumps out in 1 min

• Normal CO-4-8 L

• SV x HR=CO

Cardiac Index=cardiac output, but more accurate depending on height/weight

Stroke Volume

• The amount of blood pumped out in 1 beat (Stroke)

• Normal SV-60-110 mL

Ejection Fraction

• The % of the ventricular fill, it is ejecting

• >55%

Central Line

• Midline

• PICC line

• PA Line

• Swan Ganz

Swan Ganz

• CVP

• PAP

• Wedge Pressure

CVP-Central Venous Pressure

• Pressure in the Right Atrium

• 2-6 mmHg

PAP (Pulmonary Arterial Pressure)

• Systolic & Diastolic

• Measures pressure in both the Right ventricle & Pulmonary artery

• Systolic-20-30

• Diastolic-8-15

PAWP-Pulmonary Arterial Wedge Pressure

• Left ventricular pressure

• 8-12 mmHg